Join Dr. Lee Sharma as she welcomes Dr. Ruby Powar, a family physician in Auburn, Alabama, to discuss her journey from six part-time jobs to building a thriving private practice with her husband. Dr. Powar shares insights on setting boundaries, managing professional and personal roles, and fostering harmony in a small practice. A must-listen for physicians seeking to balance family, career, and personal growth while maintaining their calling.
Can setting boundaries transform your medical practice and personal life? Host Dr. Lee Sharma sits down with Dr. Ruby Powar, to explore her inspiring journey from Vancouver, Canada, to building a private practice alongside her husband. Drawing from her diverse experiences in urgent care, hospice, and outpatient medicine, Dr. Power shares how she prioritized family while navigating the challenges of establishing a practice. She discusses the power of internal and external boundaries to create harmony in both professional and personal spheres, offering practical strategies for conflict resolution and team-building in a small practice. From choosing not to admit patients to preserve work-life balance to learning the business side of medicine, Dr. Powar’s story weaves together themes of curiosity, resilience, and gratitude. This episode provides actionable insights for physicians aiming to align their practice with their personal values and sustain their passion for medicine.
Three Actionable Takeaways:
About the Show:
Behind every procedure, every patient encounter, lies an untold story of conflict and negotiation. Scalpel and Sword, hosted by Dr. Lee Sharma—physician, mediator, and guide—invites listeners into the unseen battles and breakthroughs of modern medicine. With real conversations, human stories, and practical tools, this podcast empowers physicians to reclaim their voices, sharpen their skills, and wield their healing power with both precision and purpose.
About the Guest:
Dr. Ruby Powar is a family physician in private practice in Auburn, Alabama, alongside her husband. A graduate of the University of West Indies and a former resident at North Shore-LIJ, she also serves as a physician for the city of Opelika. With a background in urgent care, hospice, and outpatient medicine, Dr. Powar brings a unique perspective on balancing family, professional growth, and practice management. Her journey reflects a commitment to curiosity, resilience, and fostering harmony in both her personal and professional life.
About the Host:
Dr. Lee Sharma is a gynecologist based in Auburn, AL, with over 30 years of clinical experience. She holds a Master’s in Conflict Resolution and is passionate about helping colleagues navigate workplace challenges and thrive through open conversations and practical tools.
[00:00:00] Welcome my Peaceful Warriors to the Scalpel and Sword Podcast. I'm so happy to have on the podcast today. Dr. Ruby Power. Dr. Power is a native of Vancouver, Canada. She did her medical education at the University of West Indies. She did her residency at North Shore. LIJ, did I get that right? Long Island Jewish?
Mm-hmm. Okay. And she's now currently in private practice in Auburn, Alabama with her husband. She has a beautiful son who is totally a boss, and she is definitely my sister from another Mister Dr. Power. It is wonderful to have you on the show. Thank you for having me, Dr. Sharma. I appreciate this opportunity.
Um, I got to meet you when you had first moved here with your husband, Sarah, and starting your own practice and meeting people, you were joining your father-in-law, but you were still launching your own shop.
You were finding your own place. What was that [00:01:00] like transitioning to a place, having to establish a practice? What was that experience like for you? It's been quite the interesting journey, I must say. When I first moved here, it was more with the intention of also starting a family, and between our household, we had decided that I would be the primary parent.
And that is what we had kind of agreed to. So it influenced how I chose to work. So I actually started off by taking, I actually had six part-time jobs when I first moved here. Wow. With the intention of starting a family, and that just took a little longer. Expected. So I actually did not join my husband in private practice, until later on in my career.
And I had to make a heavy decision when I first got outta residency of whether I was going to, admit to the hospital and also follow my patients [00:02:00] there. And early on, I struggled with it, but I decided not to. Be an admitting physician, but just an affiliate. Mm-hmm. And 'cause I would feel guilt and, obligation if I started admitting people to the hospital, I would feel for the rest of my career, I'd want to take care of.
Everybody the same way. So I was like, let me not set that precedence. So that's what I was doing in the beginning. I was doing a lot of outpatient practice, urgent care, hospice, nursing home, et cetera. So I did a little bit of everything. And then fast forward, now I work in private practice with my husband, and then my husband and I both are physicians for the city of Opelika.
That's where I've settled. Wow. So you really got a chance to try a lot of different things. you had six part-time practice opportunities, so you got to see a lot of different worlds, a lot of different places and ways to practice medicine. But it sounds like really [00:03:00] early on you had already kind of decided that.
Committing to doing inpatient would be something that would become ongoing. And so you already knew that your priority was to have a family and so because of that, you did not feel like that was something you could really commit to. I respect that so much because it takes a lot of forethought.
Because I think one of the things that happens to us as doctors is we start to see other people doing things and we see other people doing things. It's like, well, shoot, should I be doing that? And that can really mess with our ability to define what our individual practice life is gonna look like. I think there's a thought process sometimes that we look at what other people do and we feel like, well, should I be doing that?
And. It may not create an external conflict, but it creates an internal one, and I think you really stayed away from that. I have to give very, large credit for that to my dad, I would say, because when you just said that, it made me think [00:04:00] back to. Childhood and one thing, my parents together, but more so my father, had a bigger influence on me as far as this character building goes.
He always taught me when I was very young, he goes, you should always compete with yourself. Only yourself. He's always wanted me to reach my own potential and realize I don't have limitations. So I do understand where you're coming from in the sense of looking at how other people are setting up their lifestyle.
But I think because I had the influence early on and I kind of had my goals and my priorities in my mind of what I wanted my future to look like. I didn't have so much conflict with that. I think when I first came, I was able to expose myself to so many different fields within my own personal field. It was a blessing because it took us a little while to start [00:05:00] our family, so it gave me that opportunity.
So as time went on, more opportunities were present. I was like, well, I'm free right now. Why not? Who knows what I'll learn from this or where I may end up? So I never said no. To anything that kind of knocked on my door that was plausible 'cause I was a free bird at that moment. I love that you exercised genuine curiosity about the things that were presented to you.
It's like, well, cool. And I think that led you to finding something that you really knew that you were gonna love and sustain, but you had to have that curiosity and openness to get to that point. That's something I also think is very hard for us as doctors. If we feel like there's one right way to do X.
If there's one right way to practice and you see other people doing this, coming out of training or this person has this job situation, is that what I should be doing? And you didn't fall into that trap, you said, Nope, I'm going to try everything and see what I really enjoy. did you [00:06:00] take time as you were having all these opportunities knock on your door?
Was that a conscious thought process? Let me see what I really like. What I really enjoy. As you were doing them?
Yes and no. I don't know if I fully understand it as I was going through the process. Mm-hmm. But as I was doing it, I think I started to realize, and a key factor of that also is a supportive spouse. So my husband was the mainstay, so I had the opportunity to do this because my husband. Had his practice established with my father-in-law.
So I had less pressure on me to necessarily maybe, take care of things immediately. Like I was not in under heavy debt, like a lot of residents will come into life. Like my parents really set me up in a good way. Mm-hmm. So I think things like that you have to have a lot of gratitude for, and I appreciate it because it allowed me.
Opportunity to seek out [00:07:00] the options that were available. So I think it was multiple factors lining up. Wow. That is really cool that you were able to have the freedom to do that, that you also had the support to do it because you had a supportive spouse who was also in medicine that understood where you were and was able to support that.
It's a really interesting situation 'cause you are in practice with your spouse, so you have personal identities and professional identities. How do you manage that? That's a big question. So, you know, it's a work in progress. That's probably the best answer to say in the beginning. 'cause I feel, especially women, we.
Change every 10 years, you know, physically and just growth in general as you Find out who you are and solidify yourself as a mom, as a wife, as a physician, as just a powerful professional female, And setting boundaries personally and professionally has been [00:08:00] quite impactful.
'cause I feel that is the core foundation. Of a very stable lifestyle 'cause it helps you define expectations for yourself and others. It sets limits very clearly and it leads to a relationship with yourself that's healthy. And then from there with others. So it's been interesting 'cause I'd never been in a professional setting with my husband until.
Around COVID time, I would say, is when we finally, officially worked together and it's, it was a quite a learning curve 'cause it's at home, we run our household together and we have defined roles and that's kind of clear what we had to do in the office. But it took a while to figure out whose strengths or where, like, you know, if for example, my husband's, very good.
And prefers to kind of keep a oversight on the finances, but I also am very detail [00:09:00] oriented, so I have to do it as well. 'cause he always has the big picture, but little things can get ma missed and those little things add up. So having clear rules and boundaries in both arenas for us mm-hmm. Is what makes it successful.
Wow. I love how you start that with so much about boundaries as having a relationship with yourself that's something we, tend to think about boundaries, I think at least I do, about something that's more relationships with other people. In those interactions, but defining boundaries as something that's an internal process and having those boundaries defined internally before you can define them externally, I think a lot of times that's such a great point because it's so, I think.
Common to maybe put the cart before the horse and try to Define the boundaries that we have for our external relationships with our patients, with our colleagues, and we sort of neglect what that internal boundary should look like. We don't look inside first, but you can't do the external ones [00:10:00] without doing the internal ones.
And so it's really awesome that you did that work. First also, I do really like how you talk about this is a work in progress. This is not something, it's not finite, it's not completed. It's something that constantly is evolving. And also when you're talking about working with your spouse, I think a lot of it's like, I'll be very honest with you, I could not work with my physician, spouse.
We, would not do well working in the same building. We just would not. and we know that about ourselves. And so I always have tremendous respect for people who can do it because I know that I cannot. But you also sound like you're well aware of both of your strengths, and you were able to play to that in terms of defining what those relationships professionally would look like.
It's still a work in progress, but I definitely say yes 'cause I've known my husband for about 25 years. So I think we know each other pretty well as what we are good at and where we support each other. And even in the household it's similar. So that's [00:11:00] helped us set ourselves up for being, but you know, there's still challenges that we'll face, so.
We've realized that it's really, I feel bad for our staff, really, honestly, because it's like having two bosses, you know? And so mm-hmm. We've decided that we basically don't talk about work at home. That's a rule we have. And Friday afternoons, like if we really need to. See where we are or follow up on something, we will designate a specific time and then we will stick to that.
And that is the only time we will sit and discuss that. And if it doesn't come to a resolution, that's why we have some really wonderful people in our office that, you know, kind of take minutes. They also have their, opinion and they help us troubleshoot things. And you just walk away and you let everybody marinate in it and then we come back again.
And that is like you have to have a process of how to [00:12:00] resolve conflict or even address day-to-day issues. If I could high five you through the camera right now, I would, because Anybody listening to the podcast, that was worth your price of admission right there. The idea of having a process.
To address conflict, you have something that's already established. But the other thing that you said, which is so powerful, is you also walk away and return. And pausing. Anytime you're talking about a topic, anytime you're working through something that has the potential for conflict, anytime you can walk away from it, basically take any emotion out of it, let your thought process be more clear and have time to sort of sit with it.
You're always gonna get a better resolution. Always, and I am constantly, surprised at how often when you see practices or even hospital systems that are in conflict, that there was no preset process to [00:13:00] address it. And I think that's because a lot of times people assume that conflict is bad, or the presence of conflict means that there's a terrible problem.
The presence of conflict is normal. It's everywhere. It's all existent. And to not have a process in place to address it is basically saying we are going to ignore the conflict exists 'cause we don't have a way to deal with it. it's not treating an infection because you don't have the right drug and just the fact that you have a process just makes me love you even more.
But also the fact that you build a pause into it, that's so wise. I love that. It's all because you learn life is a learning journey and these things haven't just come to fruition. because it was innate. It's 'cause. Mm-hmm. You worked and you learned and you went back to the drawing board a billion times.
Yeah. and I feel like there's something to be said when it's your own practice. It's very different like it's your own. [00:14:00] Child. Child. And it's what sustains you, and it's your reputation and your skills and everything that you've worked so hard for. Like you're a business owner, your husband is, and you guys do it, separately, but you know it's a different animal versus when you give your autonomy away to a certain extent because that seems towards,
I found that people that are working for bigger healthcare systems, the boundaries, the conflict process, it all applies. It's just in a different arena, right? The principles are the same. You're so absolutely right. I think if you look at, you know, the 25% of us that are still independent practice owners or you know, owning our own practices and businesses, we are definitely a smaller percentage of the pie, and I think.
That percentage might be getting smaller, but I also think you may start to see that pendulum go back specifically because of that, [00:15:00] because you're not seeing the ability, unfortunately, the healthcare providers, professionals that are working in systems employed. It's hard for them to have power in that system.
And so one of the things that's gonna come up on the podcast a lot is labor disputes, strikes unions because this is how the employed, even residents are finding their voice. So as an independent physician. There is so much onus on us to be managing the system and establish the conflict resolution processes.
We're having to do that, and yet I look at the employed physicians and the systems they're in, and those systems are just as desperate for those processes. Mm-hmm. A hundred percent. I wish sometimes that in part of our training really should be. Opening our eyes to getting into a small business because we have no idea about insurance companies, how to bill [00:16:00] overhead.
Like all these things are, you know, it's quite shocking if you have no idea. Mm-hmm. And you get out, like my husband comes from family members of physicians, so he had some, idea of it, but it was completely a new animal to me, and I wish we would. Take time and infuse it throughout our training because I feel like that would build confidence in some people when they come out so they understand.
'cause I don't want it to be just a choice that I feel like some of our, Younger generation that's coming into our work field because they are trying to really hone in on boundaries and having a life work balance. They feel that if they work for a healthcare system, it makes them less responsible and that it's.
A better quality of life, and I don't feel like I agree with that a hundred percent. Like you were alluding to, there's pros and cons of both situations, but I feel like even people who don't set boundaries or get into a conflict at the root [00:17:00] of it, it's fear of something that hinders us from falling through.
Or trusting yourself fully. And so, you know, I feel like that if you infuse it into residency programs and have it specifically explored, you'd have more confidence in making a better decision. That's such a great point. one of the videos that I love, if you've ever watched Dr. Glock, flecking, and I think he's on TikTok and you know, he's basically the doctor that does all the different characters.
He also goes after UnitedHealthcare a lot, but he does a video where he talks about, you know, the medical students on rounds, the medical students getting pimped and you know, having to answer the question, but they can't answer questions about third party payers or claims or prior auths. They don't know any of that.
And the faculty's asking the medical student, how come you haven't learned any of this? And the medical student's like, well, this is what they're having me learn. I'm having to memorize all these, the cranial nerves and all this kind of stuff. It's like, well, you have a phone, right? And medical student's like, yep, here's my phone.
It's like you are walking around with a computer [00:18:00] in your pocket that you can access any journal, open evidence, whatever you need to do. But the stuff with running a business. How to hire, how to do your finances, how to make sure that you are actually bringing in enough money to keep the lights on.
Those are really the things that we need to learn. And just like you're saying, if we weren't. So undereducated about it. I think you might have more physicians who would say, I think I would like to be a business owner or a practice owner because they feel like they would have the skills to do it. I would not have done what I did without the grace of God.
My current office manager, who I've been with for 23 years, who taught me so much about business and a husband who had some business knowledge already, if I didn't have that when I was opening, I wouldn't be here now. Because I did not have that knowledge myself. Now, over time, you learn these things because it is your shop and you need to make sure that the shop is running well.
Yes, but I think it would've been a different ball [00:19:00] game if I had been in residency or medical school and felt like I had gotten some business knowledge. So I think that trend is starting to change. even if for employed physicians that are working in healthcare systems, you still have to understand how those things work and be knowledgeable about it.
If for no other reason, then it does help you set expectations. One of the things you said that I love about boundaries is boundaries help establish what expectations should look like. You know, what do you expect of me? What do you expect my workday to look like? What do my patients expect of the time that I'm gonna spend with them?
And all of those things are defined by the boundaries that we establish, and that can only come with us understanding where we are in here. It's just a really beautiful way to think about it. I think that's also been really your journey and how you've learned these things. I think that's also helped you with getting the right people on your bus because I think that's been part of your journey as well.
I. Definitely so I'm just gonna summarize how I was saying earlier when I first started my career, I was doing a lot of, [00:20:00] different part-time jobs. None of them, had me billing anything. So I was always just a paid physician that came in, made an hourly rate, um, you know, it was just all on production.
And so I didn't have to understand billing. I really didn't dive into the world of billing until I came into our own practice. And so when I started there, I started to realize in our office, like, you know, you have The face of your what is a presentation and represents you day to day, and you make 'em into departments.
Even though we are a small practice. Then you have the people that have your right hand, your nurses, you know, and then you have your auxiliary staff, like your office manager or your biller, and everybody has to be, Defined clear roles for what they are to do when it's expected. And it was very fascinating to me to learn that because, I guess being a leader,
it's [00:21:00] just a very interesting dynamic, like to come into something where you really weren't a part of, and then you kind of, and we did have to change a lot of things around. Mm-hmm. And over time, every year we've just grow, gotten stronger and stronger and stronger. And I think it's because we keep redefining and clarifying roles because I don't know if you experience this, but I experience this all the time in my own mind.
I think I'm very clear 'cause I'm speaking and articulating and I've taken time to think about it and I put something out and I sometimes will be like, huh. It really didn't translate the way I. I hadn't intended it to, but that's a beautiful thing 'cause it comes full circle. 'cause it just means I have to come back and clarify it further.
Mm-hmm. And that's where the whole team comes in because it's kind of like, Hey, where are we having the block? And as we made roles, clearer expectations, clearer boundaries, We started to get better and better quality of [00:22:00] employees and we all work better and more harmony under the roof too.
'cause we're not stepping on toes. We know, hey, this person takes care of this, this person takes care of that and this is who you answer to. And this is a process of it. Wow. That is amazing because again, this was a process for you, a process of refining what these roles look like. But there was also something else that you said that you had to sort of work through it in terms of sometimes the way that you presented a topic or a requirement wasn't always what other people understood and.
In terms of question communication, there's actually a name for that in conflict resolution literature. It's called a worldview conflict, where you're talking to somebody and you feel like what you're expressing. You're expressing clearly and yet what they're hearing because you are presenting your information from your point of view, your experience, your emotion, your lived topics, [00:23:00] all of that goes into how you present that information.
But the way the person who's receiving that information, they have. Their history, their patterns, their thought process, their experiences. And that's the filter through which they hear what you're saying. And so often we don't always take into account 'cause we don't know what that person's worldview looks like.
We know what ours looks like. And for so many of us, our worldview is so closely held. Like it, it's such a, it's such an in part of us, the way we see the world and the way we think about things that sometimes this is the story I tell about worldview conflict, that there's a couple of fish swimming in the ocean and they're swimming in the ocean, having a good time.
And an older fish swims by and says, how's the water guys? And keeps going. And the two younger fish look at each other and goes, what's water? Because they've been in it their whole lives. They don't realize that's what they're in. And so when dealing with worldview, we live in it. We swim in it.
We don't realize that. It's inherent to the way we think, the way we present information, until [00:24:00] we talk to somebody else whose worldview is completely different and we can't understand why. It's like I'm speaking a different language to them. It's 'cause you are. But I think like you said too, the longer you're with people, the longer you're around them, the more you start to understand what their worldview is.
You get to know them, you get to know that history in their context, and all of a sudden you are speaking their language. So you literally got to a point in your business that you had everybody in your building speaking the same language. And you even said it, that when that happened, it was harmony.
It was literally harmony. and I think so many people when they're. Working with people, working in a team-based situation and there's friction on the team or difficulty with communication. It is often a worldview issue, but we just don't always think about it because we don't realize that it's the water we swim in.
I love that. That's beautiful. you're the one who did it, girl. you were the one who [00:25:00] constructed it, and I think that's awesome. So this is why I appreciate having you in my life. You keep me grounded, and that was just so eloquently put, so I never heard that story before. Well, you inspired the story and you are my inspiration and you are a rock to me, my friend. So, I'm happy to be here and hear your story because this is one of those things too. We, I feel like we talk all the time. We see each other all the time, and yet there's so many elements to your story that I'm just now hearing, and it just makes me love you even more.
So That's so cool. as if I could, but I do. So that's awesome. So now that you have your team and you're starting to see, the benefits of this harmony, where do you see the practice growing? What kind of goals do you have for yourself now? I think it's Always a work in progress.
Right. So, you know, we have had a couple of, employees that are wonderful, but they're also have their life plans and mm-hmm. This is not their [00:26:00] end all. Like we had this young lady who we took under our wing and we trained her up and she learned a lot like sponge and she wanted to go to med school.
Guess what? She got in and I'm so proud of her and so she's moved on. But then we've lost a key valuable individual, so it never stops. Like you have to keep looking and finding staff. I think that's the hardest thing about having a small practice is keeping it staffed and having long-term employees.
Because sometimes you get like, you know, wonderful humans, but they are very ambitious and you want people to grow and do well, you know, so we wanna grow, but we don't wanna ever get too big for our bridges where our quality is ever compromised. So we are excited. We have a physician's assistant that's gonna be joining us, and I'm really over the moon about her.
I think her principles, her work style is very similar to us. So, that's where I see us for the, interim [00:27:00] future. And long term, I don't know. I wanna kind of practice medicine. I don't feel like I'll go to work. I feel like I'm doing what my calling is, so I wanna do it as long as I possibly can.
Sometimes I joke, my husband's idea of retirement is staying here and, doing his thing and I like to travel. So I was like, maybe six months of the years I might be on a beach somewhere, trading my knowledge and services for food and shelter
I love it. I love that so much this is the ultimate work-life balance. This is Dr. Power. I'm working from the beach. Here we go. I love it so much. That is so cool. That Would be a fabulous lifestyle. No doubt.
Ruby, thank you so much for being on the podcast. Thank you for sharing your wisdom. Thank you for sharing your story. It just means a lot to have you here. just. From the standpoint of the podcast, but also me personally, I just really appreciate your taking the time. So thank you very much. Well, I like to say thank you for asking me to be part of [00:28:00] this.
I look up to you, you inspire me on a regular basis, like starting this podcast to help so many people that you're gonna reach out to and you do so many things on a regular basis that help. Community that help women, you really inspire me and I feel so proud to have you in my life and honored when you call me your sister, and honored for you to even have asked me to speak here.
So thank you. Oh, you're gonna make me cry. Thank you, my love. I really appreciate it. Thank you to all of you peaceful warriors who have attuned into Hear us tonight. We really appreciate you being here with us. Continue the discussion. Remember that voices cure. May your choices be sharp and your voices be sharper.
Peace out, peaceful warriors.