Episode 73: Dr. Belen Amat (She/Her) of Direct Primary Care of West Michigan - Grand Rapids, MI

Dr. Belen Amat was born and raised in Mexico City, where she studied medicine at the Universidad Panamericana and graduated with honors. She decided to pursue a dual specialty in Internal Medicine and Pediatrics at GRMEP in Grand Rapids, Michigan, where she found wonderful people and a great city for her family.

Ever since she was a child, she wanted to be a doctor and help people, especially when they were sick and needed help the most. She put her life-long love of science to work figuring out complex medical issues and preventing illnesses.
 

After several years of working in large clinics and hospital networks such as Spectrum Health and St. Mary’s, she decided to start her own practice with the idea of reviving the personalized attention she believes is the basis of a quality medical service. Her research into the Direct Primary Care model showed high rates of patient satisfaction and improved medical and wellness outcomes through increased patient access and communication, so she decided to adopt this preventative model of care.

Dr. Amat believes in patient care that is based on a personal relationship between a doctor and a patient, a relationship based in trust and communication. She volunteers for medical mission trips to Honduras and offers service in Spanish for the Spanish-speaking community.
 

Dr. Amat is board-certified in Internal Medicine and Pediatrics. She is a member of the Michigan State Medical Society (MSMS), the American College of Physicians (ACP), the American Association for Physician Leadership (AAPL), and the American Academy of Pediatrics (AAP).

She opened Direct Primary Care of West Michigan July 2017.

CONTACT:

Direct Primary Care of West Michigan Website HERE

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TRANSCRIPT*

Welcome to the podcast

Dr. Amat

thank you for inviting me.

Bellin. It is so wonderful to talk with you today because prior to. This interview Dr. Clutter, Ryan had pointed out that you have run a successful DPC since 2017 and you every day in your practice are proving that DPC is not built for only the people who have more than enough means to, to pay for this access to quality care.

So with that said, I want to take a step back to your training. When you were training in medical school, you had a fifth year requirement to go out into the community and serve in a rural area. Can you tell us about that experience and how has that impacted you and your practice?

And so medical school in Mexico is six years.

So you do two years of basic science. Then you do two years old rotations, just regular rotations. And then one year of internships, if you pretty much the, you're in charge of the patients in the hospital for a whole year, and then you do a rural service. So you're actually done with medical school.

But they will not give you a license until you do this year, rural service. So you go out in my case, cause I was in that private university, we got to choose where to go based on our grades. We could choose where to go. And so that was good because as much as I wanted the rural experience, I did not want to go to that place where they drop you in a helicopter and see you later in your it.

So where I went was about three hours away from Mexico city in the mountains, it was. I was a little scared to go because I am a city girl. I grew up in Mexico city, which is 25 million people in them, all the services, and it's all fancy. And I travel all my life. So I had never lived in this kind of environment.

So when they got time to go, it's super fun because you, the town will give you the clinic. In most places, you live in the clinic in the town. I was saying we actually had a house. The town provided this house for us. As, if they didn't have power, I didn't have power. They didn't have water.

I didn't have water. And we had water once a week. So our cows had a what does that look? The collecting system. So I did have, we could fill it up. And for one week we had that water. But if for some reason there was no power. There, there was no water. So sometimes we didn't have water for a couple of weeks, which is pretty interesting.

You learn, you can live with almost anything except water. The water is the new power who cares. And we didn't have cable. It was just awesome. One of my favorite things to do, and this is obviously nothing to do with medicine, was to sit in my car and listen to the traffic report for Mexico city.

And just look at the mountains. It was just amazing. So for one year you are the town's doctor, then you are under the, the supervision of the government. A guy from the government and who you meet this public health person, not a doctor, but a public health person who you meet once a week. And they, and you just report the numbers to them of what you've seen in the week.

So diabetics pregnant people, they were the control of the pregnant people, all their follow up. And you do pretty much everything in the time when you are at the town's doctor for a whole year, we had, there were two of us, another let's go, let's do that. And me and we had 3,500 patients, let's say that lived in this town.

They're actually two towns, but they were so close together. The clinic was in the middle. So we actually have two towns. And that's what the two of us usually you're by yourself, which is found scary sometimes up in the two weeks with no security. The interesting thing too is you become part of their town.

You are, but in Mexico, the doctor's. The Dr. Wright is the priest and the doctor and whatever you say goes. So that says he was a very rich experience because it takes you out of the comfort zone of, you're double the supervision and then you're in this place that's gorgeous, but you have very little resources, there's no lab.

So you treat patients not knowing what their labs are. You take care of more complicated stuff that you would normally do where you refer people out. There's no referral. You deliver babies, which I so are the city, the closest city was a half hour away. And I would give the pregnant patients, my cell phone in new coli anytime of day and night.

And I would take them to the hospital to deliver the babies. I did not want that experience. I, that's why I met. The main reason is I did not want to be specific. Just get stuck in your head. And there's nothing you can, we didn't have a rescue box with an ambo bag. That's how bare it was by the end of the year.

We spruced up the clinic and make it better, but still you're so used to technology and exclusivity. The hospitals are pretty fancy and all of a sudden you're thrown into this and now you're practicing on your own and you don't have any supervision. You can call, your teachers from med school and ask questions, but it's not like real supervision where you could just say, Hey, can you look at this with me?

None of that.

When you're talking about resources like electricity and water, did you also have. Waxing and waning of resources that you needed to use in your clinic as well, like gloves

not so much because cause these clinics are stuck by the government.

So they actually stopped our pharmacy. It was a little like DPC. So this is a funny thing because it feels a lot, DPC feels a lot like that because we had a little pharmacy and the government gives you their formularies. So you have amoxicillin and were bacteria, a few antibiotics, a few blood pressure meds Metformin, and that's it.

You don't get anything fancy. Sometimes we would have missionary trips that were coming. From the U S which I've certain opinions about those, but they would leave medications with us. So sometimes we did have some fancy stuff that we'll use, but most times it was just what the government would provide for us.

And in general, like we did have everything in this clinic, in medical school, some of the hospitals in Mexico don't have resources. So yes, you have to bring your own gloves or you're doing an exam without gloves. So I'm like no, I am bringing my own gloves. Thank you very much. So yeah, some of the PR the public hospitals don't have resources and you just have to do your own, but the clinic was pretty well-stocked.

One of the benefits we had is it had a power like a backup generator. So even if the town didn't have electricity, we had electricity in the clinic, so we could use the shower. If a kid came in with a fever, the first thing we would have, they were nursing students also because the nursing students were also doing the rural service and we would have the nurse, okay.

Get the kid in the shower and try to bring them comparator down before we see them. It was so nice to make the kid comfortable. So in that sense, and we could ask for stuff because this clinic I was in had a foundation from a religious group that was in town. So sometimes we could ask for things.

We actually had a kid who was on peritoneal dialysis during our year. I know. So my student diagnosis kid with renal failure, he came in full nephrotic syndrome. He was as the whole thing and she had no labs and she diagnosed since this is renal failure. We were able to send him to Mexico city to get a catheter put in and the bags of solution.

And here you go through your dial system. So their house, they were very poor and their house had like dirt floor. And of course they had no power and of course they had nothing else. So the mom would bring the kid to the clinic every day and she learned how to do the bag exchange. And we had a microwave, so she could warm up the solution.

And we did prevail dialysis for a whole year for this kid. And he ended up getting a transplant for that. But it was a really great experience because of course you see all the complications from. The dialysis without labs. So he, once had seizures. And so they called us, somebody came running, let's like, you could make a movie out of this.

This person came running because their house, you couldn't get to their house with a car. So they came running and he's having he's something's wrong. He's not responding. So there I go in, they had a truck, like a a big fancy truck with four by four. So we drove as far as we could. And then we ran up the hill to get this kid out of his house and yeah, he was having a Kingston status of electric cars.

So we grabbed it. I This is I would never do this, like in a normal situation, but it's he's going to die. We put them in our, in the back of the truck with the mom and my friend. And we drove into the city into the hospital and ran into the hospital and just here's this kid, he did fine, but oh my God, that was scary.

So yeah, it was her. Oh my God. But I don't think I had any like bad experiences. Sometimes things can happen where patients die and there's nothing you can do. I didn't have any of those experiences. I did hear from some of my classmates, that maybe a baby will die in delivery or, maybe the town didn't like them and then, they will make your life miserable.

So my experience was really good and I loved it. It's a little bit like DPC because you really know the people because you're in the town, where they are. You see, When they're drunk, you see when they're like slipping around, you see all these things that, you know, the CPC to because you become part of the community, which is the way it shook me.

Even though, like you're saying the doctor and the priest are at the top of the social pyramid or whatever you want to call it you were still part of the community because you were there for a whole year living within those two villages.

So that's incredible. when you had transitioned, you finished your year doing this internship and you made your way to grand rapids. You did your training. At what point did you learn about.

So I, the first time I heard about DPC, I was already working. I was employed my a kind of a Catholic hospital that had an FQHC for Hispanic patients and also homeless clinics.

So I was working with them, loved working with them because that's what I wanted to do anyway. So I the first I was just remembering, cause I I just had this like flashback when I was looking at your podcasts and you'd interviewed, you talked to Garrison Bliss and so the first, my first contact with DPC was an article he wrote, and this was maybe a year or two into being employed.

When I already knew that employed was not for me. The difficult thing was you get sucked in back into this whirlwind of being exploited. And I did not have time to think about breaking through. Until I think my mental health and my health in general was a stake in my family and everything. But every few months I would get back out again and try and look.

And there wasn't a lot out. This is like 2011. Not a lot of GPCs were out there. So here and there, I would hear things. And eventually I went to the first nuts and bolts and that's how I jumped ship. I went to the conference and by the end of that conference, actually not even the end, we met first to socialize and I actually went up to my room and call my husband.

And I said, this is it. I'm jumping ship. And I got back from the conference. What, October? November, I quit in December. And six months later, I was opening, you know, that you have to work for six months as a penance after your quit. But that was how it was. So that was the first experience.

But then that's how I can keep looking for a way out and then would get stuck back in. And it happens when you're employed is things got a little better, so you're okay. And then you move it again down. And then you're done, it's done for six months. So then all of a sudden you can breathe a little.

And I think it's the way the system is designed to keep you on. Who wants to bring you on in first year is this, let's tighten it a little bit and then let go a little bit and the, a little work. So you get used to it too. You're like, it's not that bad anymore.

And the golden handcuffs of, oh, we'll give you the salary.

And then after so many years, we're going to take that salary away because you are so deep into the system that you have to keep working because we've given you money potentially for your mortgage and you've already purchased a home here. And so it's really hard to pick up and leave.

You're so deprived when you arrested ants. Maybe the difference in my experience to other physicians was I did not grow up here and I didn't have loans because I went to med school in Mexico. So then I can start my professional life with these horrible loans and this, all these restrictions, I was on a visa.

So I did have some restrictions. I couldn't just go on my own. So I did have to wait for me to be able to not have a sponsor working on my own, but I didn't have that many. You know, They'll set the golden cuffs of being stuck because now you have this mortgage and we actually, you probably know it. But what we did as a family is to plan to go to DPC is cut back on the lifestyle first, because the last thing you want is going your own, and then you can't keep up because your bills are horrible, right?

Your mortgage is terrible, your loans are terrible. And then you want to keep up with this lifestyle with this income, that doesn't work. So

definitely when you mentioned visa. So I want to go back and ask when you had transitioned from Mexico city and medical school and your internship, you were at St.

Mary's. Is that correct?

The first I was at St. Mary's yes. When I finished residency. Yeah.

Yep. So after residency, you would, you had been employed for a bit. when you talk about that, you had to have some sort of supervision until a certain point with the visa in the picture. Did you have to have any supervision after opening your DPC?

no, no, no, No. with the visa, all that they do is more of, it's just a sponsorship. So it's not like you have to have somebody watching over and make sure you don't get patients. That's not that kind of supervision. It's more, you have to work these hours. You can't work anywhere else. This it's more like an extension of residency in a way you work more hours than people don't know this, but doctors that are on visas work more hours and get paid the same or less because clinical hours are 32 hours per week.

Most people get paid for 32. We have to work 44, the RESA. So you work 40 hours, 40 clinical hours, patient hours. On top of Lynn doing your charts and all this other stuff. So those 40 hours, or just to patient care. So you work more hours seeing patients, but you get to the same poreless. In my case, it was probably less because I listened to SQHC. So you get paid the same as the docs that are in the fancy neighborhoods, which is, to me, it was like, that was one of the things I was able to fix. Right? As I left that hospital, they changed the compensation of the physicians that worked in a few HC and homeless clinic after me bugging them for years and in every meeting they finally changed it.

So I feel that it was a little check mark of, I made it my contribution. At least the physicians that are left in that environment, at least don't have to. Fight with that, this one

listening.

Yeah. What a wonderful impact, a lasting impact that you left in your residency and in your community, so with that, I want to ask when you decided to do DPC, when you had read Garrison's article, when you had gone to nuts and bolts after you had called your husband between when you quit in December and June, when you opened in 2017, what was going on in your mind in terms of. This is the DPC that I'm going to create.

What were the goals that you had for yourself when you were about to open?

So when I, you always have to, any business you make, you have to have an ideal picture of what it looks like. So in my book, and this is funny, cause it's not, it wasn't about the number of patients.

It wasn't about the hours. I would work. None of that. I'm not like that. So I just, my goals are never like that. So in my mind, I wanted a place where the patients could just come in and sit down and have a cup of coffee with me. That was where they'd pictured. And then what I did is materialize that. So it would look like my dream.

So you know how, when you have a dream and you see a house and it's so clear in your mind, but if somebody told you, draw the house, you can. But if you see it, do you know it right? If you recognize it, you're like, that's what it looks like. So that's how I found my space after months and months, because I started looking at space from January.

So I was still employed. I started looking at office space and I was like, Ooh, no, that does not look at all. It's like same setup, right? You come in, there's a waiting area with a little window thing with the glass, which is so annoying. And then there's the person sitting there, which then makes it, wasn't going to be anybody.

And then you have the hallway with the rooms on one side. And then the other side has the storage. Every medical facilities like that. So every space was like that. And I had to get the realtor to understand she kept sitting concierge, which just annoyed me. And I'm like, can you tell, understand, first of all, it's not concierge.

And second of all, I need a space where it feels like this and she couldn't get it a bit. She, at some point is switching her head. When I kept saying no to this. We said, let's look at something completely different. Thank you. And so she took me to this office and I looked, and it was like in the winter.

So the view wasn't the greatest. It was all great. And I'm like, this is it. And I just knew it was the same with the furniture and the same with every painting and every little thing I put in the office, it just goes with that. That plan, that final plan. Now, organizing all this? Did I know what I was going to do day to day?

No, I didn't have a clue. Did I? And I wasn't part of the DPC Facebook group at all, because I had my no compete was very scary and the hospital was like watching me and they said, you can not do anything online until this state. And so I was very careful and maybe it was just paranoia on my side, but it was wholly writing.

So I, my lawyer was like, yeah, you probably shouldn't lay low. So I didn't advertise. I didn't do, I didn't publish my website until exactly the date that it said on that out-compete that I could, open. So that actually was. I didn't really have a clear idea in my mind of how was it going to see patients and all always saying it was funny because my husband, he said, shouldn't you do like a dry run let's practice.

So I'll pretend to be your patient. And I was like, I don't have to do that because I actually know how to do that. What I don't know is where to get supplies and furniture and an exam table. And, oh, I didn't know. You had to do the sharps thing and then, oh, to get a clear, to do clear wave tests, all these things that I found a lot more by chance poor talking to other people and they'd be like, did you get this permit?

I'm like, sure. I have it. Of course not. You'd find out that you're doing things going to so that is my learning point for people it's do your research. But I did not have a clear idea of where I wanted to go. I just. Just thought I would do what everybody else was doing, which is 600 patients.

I think you asked me about the prices at some point, I didn't come up with the prices I store the prices that other was doing. Like if it works in Kansas, why can't it work in rabbits? So the only thing I did is I didn't go as high as most people for the older people. So kids are twenty-five if they're by themselves, which I changed.

So that's a big learning point. Kids, if they're by themselves, don't charge as a family because it's just like three care. If they're part of a family, then I do this counseling. So if it's, and I have a large families that have five kids, seven kids, and I think it's a great help to them. If I don't charge Brazilian, doesn't really have to see the kids.

So by being at peace, I can do that because I compensate with the adults. So my adults pay mostly 50 and that's my fist. My biggest panel is in the 15 range. And then 75, 4 people out of 52 older. I don't have a ton of older people. I wish I had more. And I always thought about maybe it's the price.

And it could be because the price kind of fits my, my people. So the 50 is a perfect price for.

When you visualized your ideal patient opening the clinic um, versus your ideal patient now, has that changed?

Totally. So one of my worries during the PC, when I would see what people would say about DPC was that I was going to just tend to the worried well right?

It's all this healthy people that really don't need me, but they want to just the reassurance that they're okay. And they take up all their time and energy, their energy sucks so I thought that was. My people, I thought that I'm giving up on the Hispanic community and all the people that can't afford this.

But to me that wasn't another choice at this point. It was like, I either do this or I quit medicine. So I hadn't given up on that. I say, I'll compensate doing other things, but in my practice, I'm just going to be here. I was thinking of myself more of a concierge. Like it would end up being more that kind of practice.

Oh my God was, I surprised that was not the case. So that was a big surprise. And let me tell you how that happened, because it was very interesting. I went to the chamber of commerce. Everybody should go to the chamber of commerce. Honestly. That's how you get to meet people is first thing, because I'm like, how do you like meet other people and tell them about DPC and how do you get patients?

And I was not in that Facebook group to ask them,. I didn't use to email Josh hunger and he would give me advice, but he wasn't here to see the town, to understand this town. So I went to the chamber and I made an appointment with the guy that does business development. Lo and behold, I knew him from before because he is also Hispanic.

He's from Texas, but his family's from Mexico. And he knew me from before. And the value of being in the same town keeping the same time, not, we didn't know each other really well, but we seen each other at events. And then when I explained to him, when did he see what's was like, that's amazing.

Why isn't everybody doing this? And he's this would be a huge hit with the Hispanic community. And I was like, oh, I didn't think about it. So what he did, which was brilliant, he set up a press conference at the chamber. In Spanish for the Spanish speaking media. So then I had the newspapers and the radio that are for the Hispanic community.

And then these guys interviewed me guys because there were no, no women, really. And after that, I got invited to radio interviews. I did write for the newspaper for me a couple of years where I would write a little column in their weekly newspaper about like Coles. And how did you do cancer screening and how to take over over the counter medicines and, just very basic and did some exchanges, right?

It's I'll write your column, but you give them an ad. And we still do things like that. I still participate, even though I'm full, I still help them when they have an event or the radio all through the first year of COVID. I did interviews everywhere. To keep up with, the information for the Hispanic community.

So it's more than just where do I get patients is how do I integrate myself into a community where I've been a stranger I've been up in the, the castle St. Patients not having to do anything with the community. Yeah, maybe you go to an event or two, but you're not ingrained in the culture.

So I, that was the way I connected. And it was so eye opening because I didn't even have brochures in Spanish. Okay. I had to emergently call my sister-in-law who did my brochures and say, I need them in Spanish, like stat, because we have this first conference next week. And so that helped. And that's how I did have no idea this was going to happen.

And I was able to just say, oh, okay, let's do this. And a majority of my patients are Spanish speaking. I would say about. Easily. If my patients are Spanish-speaking wonderful.

And I just, I go back to how you shared about your experience in your internship area. Like you completely were a stranger to that community and you did the same thing there.

You had to become part of your community to serve your community to the best of your ability. So that's wonderful. Now let me ask, in terms of the patient population, you said two thirds about are Spanish speaking. What about in terms of insurance? What types of insurance do people have

most, I would say. And that I probably should redo the numbers cause it's been a few months, but out of my Spanish speaking patients, I would say maybe 20% have insurance, the rest don't I have a good, solid number of undocumented patients that don't, that I actually know their real name and they, I don't want to know what they're doing and how they work.

I don't want to know, but they trust me because I speak Spanish and I understand the culture, even though in Mexico, I'm not kind of part of their town because in Mexico I'm also separated socially, because I had an education and was, my parents were from Spain. And so you're not like from there culturally in a lot of ways they still are like, you speak Spanish from you also understand our culture.

You understand how we eat, you understand how we relate to. You understand the family, the church, all these things that make up our culture. I understand them. And it doesn't matter if somebody is from Peru, there's little variation, it's oh, you eat this instead of that. But in the end, we are one little cultural, red, little variation.

If you go to different countries. So it's not just speaking Spanish, there's a lot of them would say, yeah, I see this other doctor that speaks Spanish, but they're American. So then they're like, oh, it's bleeding. So then they're like, they don't understand me. And you add the unrushed thing that they know they're used to that because that's how they had seen the doctor in their country.

So to them, it's like going back to how they used to and in Mexico. And that probably happens in a lot of Latin America. People pay to see the doctor. So they're not against paying and the $50 a month. Perfect pricing for them. A lot of people say, oh, you're under Riley wing or whatever.

It depends on your patient population for my population. That's the perfect price. Now, do I have some rich people that love it because it's so inexpensive to see me, right? Yeah. I have a few people like that, that you're like, okay, you could spend a little more, but I'm not going to treat them different.

They maybe they're with me because they liked the personal thing or they liked the fact that I'm not going to be bugging them for everything. Like you have to come in for another role there. So I'm there. If you need me, I'm not going to like, hold you. So yes, the majority of my patients are not insured, which sometimes it's easier because then I don't have to do a prior off.

I don't have to worry about prescription coverage. I just. Treat them with generic medications. That challenge is if they need a specialist, that's a challenge. Most of them don't ma don't mind paying, obviously this, these are not patients that are, would be like in the Medicaid kind of range.

The people that can't even afford $50 a month that's why there's Medicaid and there's these clinics right there. Can you see what I used to work? Where they do a sliding scale? That's the place for somebody that cannot afford 50, but most of the people I see are just little tiny above that they're factory workers, farm workers.

I haven't taught a ton of like how farmers, which is, I don't know, they talk to each other. It's very interesting to me because I don't know that here, it works. So I always want to know it was like, how are we doing and what do you do? And what hours do you work? And what did he do when you're working?

And I want to understand. You know what it is to go at three in the morning and get the counts out. It's, we have a few inches of snow maybe or ice there's three in the morning and you have to get cows out. Oh, goodness gracious. Yeah. So very interesting. I love learning about what people are doing in their lives.

These are the details that I feel that just in my short time, in my own DPC clinic, I know my patients way better now, even the ones I've taken care of for over six years.

I'm like, I didn't know that about you now that you are full, what is your maximum number that you are comfortable with in terms of number of patients and how do you manage your wait list for people who are still interested in your practice, but haven't yet joined?

So what I it's funny, cause I, I thought I would do 600.

And then when you see how intensive. It was like, I'm not sure I want to just 600. That sounds like a lot. And then you get to a hundred and you're like that's not too bad. And then you do one 50 and 200 and you're like, it's not too bad. You know, you kind of adjust people settle in. It's so much work at the beginning.

When people talk about the turn of the beginning, it's settled down. So it's five years and I'm like, I'm good. I'm comfortable. I don't have as much chair. There's always, people who move or people who all of a sudden changed insurance and think that the breast is green and go, we'll see you in six months, experience that and then come back.

So what I do, so right now I'm like between 303 50 is, might happen. Number, I think, where I still have enough free time to do other things, because I don't want to be seeing patients all day long, honestly, because I think the richer experience of being a physician is being able to do other things, you want to be. A better person. So to be a very personal, I have to have time to be with my family. I have to have time to do CME, not just force myself, but say, oh, I haven't read about this in a while. Or you see something interesting and a specialist suggested diagnosis or oh, I need to read up on that again.

It never ends, you always have to study. And then other things that are nonmedical, maybe I want time to read books, concept of reading that is not medical. Maybe I have one time to, to go away for vacation. Maybe I want time to explore different businesses. So once you settle in comfy practice then is when you can let your creativity go again and say, okay, I'm done running the churn of the building a practice and getting it to a decent size.

What do I want to do next? So for me, I do have the syndrome of the shiny object little bit, which is not, it's not bad. I don't see it as a bad thing. The promise, if you just chase shiny objects and never do anything, but most of the shiny objects I've chased and pin down have become really good things that I've been able to do.

So I love the greeting about different things and different businesses that I could do some related to medicine seminars and really doing those other things also for income, because why not this? I want to retire at some point. So some things are not, money-related like participating in organized medicine, right?

Being more involved in the Kent county medical society and the Michigan state medical society and understanding how all this all such as many and how messy it is and how hard it is to change anything. In the law and in medicine and how everybody's got their interests and their, and in the bucket.

So trying to get more involved in that and also fighting for other physicians and for our patients. So to me, having time to go to those meetings, to do a legislator day and go talk to politicians, to me, it's so fun. So if they say, Hey, next Wednesday, we need somebody to come and talk about prior auth in Lansing to the legislator.

So I'm like, sign me up clear my day and I'm done. So having that freedom to say, I don't have, you know, 15, 18, 20 patients in a day. And some DPCs do that. They do have the same schedule that they would have had in a it's more relaxed, but it's still pretty busy. I think being busy, so overrated, I don't want to do busy.

I don't like being busy. I like having time to think. And. Enjoy life. And I also want to do other things. So I think 300 to three 50 has been my good number. Could I take more maybe, but then I probably would have to hire staff. I don't want to hire anybody right now. I'm good where I am at.

I have a nurse that works from home who used to work for me. Not for me, but with me in the literacy. And she is on some and I'm just waiting for her to be done, having babies so she can work physical the clinics. She knows it, come on, Jan, stop having babies. But she loves her family and everything.

And so we are very flexible working with her and she's so good as a nurse, she's just super organized, which I'm not is who she, and she keeps me honest, she'd be like, oh, I wash station. And I'm like, you need you don't have to be safety capitalistic who cares I'll get it. So she keeps me on track to OSHA and the state and plea on all these sayings and making sure I'm not breaking them all, which is good.

She helps me with some of this stuff. I don't like doing requesting records and doing prior all it's I don't like that stuff and I procrastinate and don't like doing it. So that's a good thing to hire somebody to do the things you're not good at, but also the things you don't like doing.

So I don't mind taking care of the pharmacy. I don't mind doing the prescriptions myself. Some people hate doing the pharmacy side and want to hire somebody to do that. To me, I liked that part. I like to do the pills and being home in that there are parts that I just oh, goodness gracious. I guess I could some other things I could delegate to her, but I'm comfortable where I'm at.

I'm trying to explore some other things.

As you've run your clinic since 2017 to now, have you toyed with hiring other people and if so, how has that gone for you?

So I'm in and out and the idea I am like, I probably shouldn't have somebody can a blog cause I don't want to drive a lot.

I probably couldn't do it, but I had to do it in Mexico when I was a student. So I probably could draw blood. Do I really want to do that? Not really. So it's one of those things where I'm back and forth right now. There's like nobody who can hire. So it's really hard to find somebody I. Look at the end of last year.

And then I'm like, yeah, no, I'm good. I don't need somebody. And then I changed back and forth because it's more work to hire somebody. You have to train them, you have to supervise, you have to make sure that they're doing, it's not like you just delegate and you're, don't ever look at anything. You, it generates a lot of work to supervise somebody.

So it does take some things off of your plate, but it adds some other things. That's why I think I decided to not grow more because it adds more administrative stuff that I don't want to do. Doing their performance reviews or making sure that whatever compliance things for somebody else.

I'm good. I'm good with doing my compliance stuff, but I have to be like the HR things. And having to, oh, they're sick now. What did you do or now they're happy. How do you fix it? I don't know. I just don't. If you'd asked me 10 years ago, I thought I would be like the CEO kind of person. And I'm not I like to lead, but I like people to do their own thing.

So in a way, I don't know, I just have changed my opinion about hiring staff many times. I've had some bad experiences too, where you hire somebody and the drama, is can you just get to work and stuff with the drama? And when you're employed, you don't deal with any of that, right?

Somebody has some drama, you don't all somebody then come to work here. Some other roommate, or today you're going to run under staffed and you just deal with it. But having to actually be the person who fires somebody. Oh, it's horrible. So I'm not cut for that. And I think one of the things that I like about DPC is I'm learning all these.

That I thought I would like that. I don't mind once I do them, I'm like, Ooh, I don't think I want to do that again. As far as physicians, I have learned that I like to work by myself. I enjoy being by myself. One thing that I have done, I really talk about this, but that I have done in the last I'd say year or so is that I expanded my clinic.

So I had only one exam room, which is fine for me. And then the waiting area and a storage area and the storage was my office. So then what I did is the space next to me became available. I'm in this a building that's like a three story building that has, it's mostly lawyers and business people like financial advisors.

There's a couple of health-related like massage, other things, but mostly financial and lawyers. And the suite next to me came over. So I'm like, Ooh, maybe I could do a little more space. My lease was up. And I was like, maybe it's time to grow the space. I don't know. Maybe. So then I talked to my, my accountant, my lawyer, everybody, and see, is this a good idea?

And that a good idea. So it's good to have other people. So those are things I don't do myself. I have an accountant that does all the money, things on the taxes. And I have a lawyer who I call and say, Hey, what do you think about this? Given, is this a good idea? And they know me really well, so it's my team, but they're not physically in the office.

That's my team is people I can call and say, is this a good idea or not? So what I did is when I opened this extra space is my here goes again like that dream of what it looks like that I don't know how it's going to be. It's starting to turn out in this kind of form is to have space.

Available turnkey for DPC doctors that want to start so that you know how scary it is to pay your own rent at the beginning. And it's overwhelming to have all the OSHA sharps clean, all the things we talked about, insurance, internet phones. Everything you have to get your own office when you don't have patients yet.

It's so scary because they're like you see the bills coming in and you have five people, 10 people it's nerve wrecking at the beginning. So one of the things I thought I will do, and it's just, this is just starting to come to fruition is to have a space, a room that is Turkey for DPC docs or docs that want to break free, but they're scared to do it on their own.

And here's the space. You don't have to figure anything out. The sharp thing is taken care of you. Come in, you see your patients, And you're just paying an amount per day. At some point you might have enough patients that this is not worth for you anymore, but then fly right fly little birdie is what I want.

I don't want somebody to be with me all the time. I want somebody who then grows and gets in their own space, or maybe once somebody wants to work part time and they don't want to have an office and the hassle and the cost of an office, but they know that they're going to work maybe one day a week or two.

Maybe that's somebody that long-term can stay and work the day or two in my extra rooms. But I see it more as though that's an incubator of baby DPC doctors, where they can for a few months, rent from me and then once they're ready and they have enough patients to get a place, then they can get a place.

But it's not like a, it's not a thing that will stop them from doing.

Absolutely. And when you see commercial leases, typically three years, unless you can negotiate that down, it's a pretty penny, when you think about, dollar per square foot, triple net lease all of those things and it, it totally adds up.

So I love that you have this idea in the stream and you've now expanded into another space to make that potentially happen for other people as this movement continues to grow, especially in Michigan. So that's awesome. Now, I want to ask this because Being a solo doctor, myself in DPC, how do you maintain boundaries with patients, especially if patients are, messaging you multiple times a day, or if they are calling you after hours, how do you handle boundaries with your

patients?

So I don't sugarcoat a lot of things. I am who I am and that's one of the hard things about if I don't like somebody, I can't hide it. I don't have a poker face. It's for good and bad. That's horrible. I just don't. So when I have an issue with a patient messaging me after hours, or it depends on the situation.

Maybe it's that co farmer. And he works from four in the morning till whatever. And then he just wakes up at five in the afternoon. So that's that to me, doesn't bother me. So that doesn't bother me because I understand that Citra. So that's when knowing your patients, is that's the difference.

If it's the person that's just sitting at home doing nothing and then has had a cough for three weeks and they decide to text you on a Saturday, I'm like, okay, you know what? This is not appropriate. What I do is first I take a deep breath and this is one of the benefits of text is that they don't get to see my face and my eye rolling.

So when that happens, I just like deep breath. And I do not ever say anything in texts like that, that I would, I don't put boundaries on, on, on texts because they could read it completely wrong or an email. I even, I would rethink different, right? You read with your own tongue. So I take care of them and they say, not a problem.

Let me take care of you. And I do whatever we need to take care of them in that moment. And then they get put on a list. So I have a little list of the people. I need to talk to them about boundaries in person. So what the next up. So I don't bring them in for that. The next time I see them, then I talk about it and they say, Hey, you know what?

The night, I always try to use humor because that helps. I've noticed that you always ask for your prescription on a weekend, or you always want your refill when I'm on vacation. Even though I sent the email reminder, you always are the you're the one person that texts me in the middle of my vacation and I have no problem refilling it.

Can you tell me why? Why is this going on? And a lot of times like, oh, I'm sorry, doc. I didn't realize I'm so sorry. And they stopped doing that. But I just tell them how I feel. And I said, you do realize that when you texting me, you just broke my vacation, even though it's not an emergency.

And they say, you're sick. Certainly it's appropriate if you're not sick and you just forgot, you just wait until I come back. But some people get it and they understand, and they're like, oh yeah, of course, it's you they understand this, you answering the phone. So that has helped a lot.

Is I deal with it in person, there are people that just don't understand the difference between what's urgent and what's not, and they don't know what time of the is. I had one patient, a very difficult patients years ago who honestly would have the conversation. And she kicks him so much.

And I still, I would see her every two weeks. So it's not like somebody, I wouldn't see months. We had scheduled appointment because of this anxiety. I don't feel like what's going to happen with my habit and I can I reach you? Can I get an answer? We had this honest conversation. I said, this is not good.

This is not going well. This is a relationship is both ways. And you're not understanding this. And so we had, a heart to heart and she said, I honestly don't know what surgeon that wants everything for her. It surgeons everything in her mind. It's an emergency. So I said, how about we train you every time you contact me?

I'll tell you. That's no problem. So I did that. I sorta like the nine months till forever, every time she contact me. So she's one that would send me, can I get some physical therapy for my knee? And it would be Christmas morning. And you'd be like, this is not an appropriate call. I'll deal with this.

When I come back to the office. So by training this person, it actually ended up working and she settled down and she understood the boundaries started to clear. So some people did take longer. I there's certain things. I just don't allow somebody else's video calls me something. It's like a no brainer right.

Out the door. And I'd had people who do that. So horrible. Cause I don't like aggression. I'm always very friendly with the patients and almost jumping around. So to me, somebody calling me something or telling me that it's about the money, right? Oh yeah. This does not working. And I do tell patients, it's both ways.

It's you being happy with me, but also me enjoying your company. Cause if I dread seeing you, or if I see a text and I just roll my eyes 50 times, this is not a relationship, this little place. So I try to mend it and fix it. And if it gets fixed, I don't hold a grudge. I don't like, remember when last year you texted me and my vacation, I don't that's my brain.

So yeah, boundaries are hard because we usually in the employed world and a lot of people in DPC to have somebody else answering the calls or triaging. So then in a way you don't deal with that. You remove yourself from that. And if somebody has a problem, you call the managers to deal with this person.

I can't stand it. When it's CPC, it's you, who has to fire a patient is you has to go down the research hard. Cause we don't get taught to do that. And I don't think anybody can teach you. You have to learn. To do it because it's a personality. It should. Some things that might drive me nuts when I drive other people not.

So we see it all the time on their Facebook conversations, especially in our, on our women group

priceless, where some people are like some things driving me nuts and I'm like, that doesn't sound bad at all. Yeah. But I bet you there's things I post that people would say that's a big thing. And so you can't be taught you can't be warned. So it's good to know that you have to do with. All the, rainbows and unicorns that we promise and DPC.

It's good to know that there are some sides of it that it's oh my God, what do you mean? You have to deal with this. I'm the one that has to like chase payments of field charges with now I had that. So my nurse is can you just chase this? I don't like chasing money. So yeah, it's hard and nobody can teach you.

You have to learn on your own. And it doesn't matter how many times people tell you not to do certain things. We all have to go through the experience.

Yeah, there was a I think it's a Tik TOK meme. People are using this quote that is talking about how a practice does not equal perfection practice equals learning to improve.

In the future. And so this idea that you can't be taught you what your own boundaries are. It's so true. And just, having spoken with people for this podcast, having read posts on DPC docs, having spoken with people in person, it's definitely something where. Any information that you hear from people it's sick, you take it in, you take what can help you in your practice.

And then you, you put that out and you see if it works for you. And if it doesn't, you just pivot and try something else. But I will say that for me, I love that. You're constantly just adjusting to your patients and just this idea of. Some people don't know what's acute I've found that to be the case, especially when people are new to the practice

so like in my practice, I have an acute line for only members. And then I have my regular clinic line open. For normal business hours and people can leave messages after hours. But so I had a patient call both lines because this patient didn't know which one was appropriate.

And so I love that, you know, just educating them up the spot. Okay. You did the right thing. You absolutely did the right thing. And I'm sure your patients have experienced this is that they understand. And many people have talked about this before on the podcast, but they understand that, oh, She's not joking.

When she says that she's available and accessible, she's actually available and accessible. It's So I love how you talk about your boundaries in your clinic.

Now I wanna talk about your involvement in the medical society.

Local to you, as well as on the state level you've highlighted how you've been able to have time to do stuff like talk at the legislative branch in Lansing, but in terms of your involvement in the Michigan state medical society, being on board there, as well as now, president of the Kent county medical society, when you are talking amongst those organizations um, have you been able to affect the perception of DPC just within your local and state communities?

And if so,

how? Yeah. So when I joined the county medical society, they invited me to do a talk. So I actually did a presentation of what DPC is. Every time when we talk to other physicians, I think the majority of docs nowadays know the difference when they don't. I correct them. And I'd say, it's not concierge as DPC.

And I think that they get that also from how we're fusty and they start talking about stuff that is so Dory about floating and Billy. And I'm like, oh dear Lord, I'm glad I don't have to do any of that. And they still, like, their eyes are open and they like, what do you mean? You don't have to do that.

And what's great too, is talking to residents. So one of the things that happened to me is the same place I quit and they hated me because I quit, you know how it is, you're either in or you're in and we love you. Or you are out there. You're our enemy, right? You can't be out there and we're friends.

The funny thing is I got invited to talk to us. After I quit. Cause if you do realize that you just, I just had to quit working for you because I hate your hospital. Not personally, but the institution itself, the system and no, that's, it's fine. You do realize that. I might say things that you might not like.

No, that's cool. So every year I get invited to talk to residents and they love it because I say things that other people don't, they're saying. And when I got invited to be on the board, I did tell my directors, the admin people and say, sometimes I need to put like, you need to kick me or, under the table or something, because I might say things that are, I don't have much of a filter anymore.

And that's, I think in the PC thing is we lose our filter. They love it. They love that. I can see things that they. There say, or they can't because they're employed. So they can't go to an event with the medical society and complain about hospitals, because guess what? You're in the system.

So you can't say those things, but I can. So I think they have, I don't think it's just me, there are more VPC docs now, so they're all like, oh, you like that other doc and like Detroit or another side of Lansing and they, I think it's becoming more a thing. And the more we talk to students and residents, it will be you won't, they won't be blindsided.

If I had known before I graduated about the procedure, maybe I should, maybe I would have done things a little different. Maybe, I still had to get drunk because I had a visa, but maybe I would've planned sooner instead of burning out the recovery is horrible. It takes you forever. Yeah.

And

in some ways the feelings never leave you, but

yeah. You do you, I, every time I have to go to the hospital for something, I get oh my God, just somebody's going to show up and say, you have three patients waiting and you're already half hour behind and Peter's not working obviously.

Yeah, absolutely. I laugh because there's the, that's the only that's my reaction to, to cope with that. But everything you say I can relate to that. And I'm sure a lot of listeners can as well.

Over your time, learning about DPC, researching DPC, doing DPC, thriving at DPC. What are some of the best resources that you could recommend to others who who are interested in DPC? No matter if they be a medical student or in residency or in fee for service?

I think it, of course it depends on everybody's journey.

I think I was meant to do things that, where I was home to do them. I think I'm here because of the path I've done. It's not like you just wake up one day and it happens. I don't know that I would have done a lot different maybe, like I said, if I had known that earlier, but also you have to be open to hearing things.

So maybe I wouldn't have even seen it. Somebody would send DPC. I don't think I would've seen it because I didn't consider it the same way that, you know, when I was in residency in, we do all these rotations. I think the first time I wrote it in the private practice, that was not on my, the hospital was in my third year or like end of my second year.

And I was like, oh, this exists. I had known from Mexico that there's other ways to do medicine. And through my medical school rotations in the us, I'd seen lots of systems. I did tons of away rotations, but I didn't know that here in grand rapids, that was an option. I was like, oh, I thought you all had to be in that part of the hospital.

And so that was eye opening, but I don't know that I would've seen it. I think that it was one of those things that you have to go through the pain to open your eyes and look for something else. So resources. I there's a lot now. There wasn't much, 10 years ago or five years ago. I listened to every podcast.

I could get my hands on when I was thinking of jumping and trying to hear what other people were doing, going to conferences for sure. Because of meeting the people who are doing the BC is the most important thing. Even when we've been, like you say thriving, you're like signing, you're saying, I feel like

I even get a lot of stuff going to conferences because some people are doing things different and the, not so much sitting in the lecture, but being outside the lecture in hearing, oh, you're doing what, oh, you do that. Or you hired, a mid-level how do you do that? And how you, how do you do the actual reality of having somebody in your practice?

Or would you have another physician or another location or all these things that we do? There's so many. To do the PC. It's so rich when you actually talk to the people. So first reading all the books you can read by, you know, the Alfredo and listen to all the podcasts, all this information that is not on paper, right?

Shane. Company, how to approach big balers. It's awesome that we have this books now, Julie also has a book. All these people that are dying to tell their stories. Amazing. It's so rich. So I would say, just read everything you can read, listen to every podcast, get on the Facebook groups because you see all the questions, people ask the same thing over and over.

So you can see that it's this churning machine of information in meeting the people. So if there's conference, I just go to the conferences because hopefully in person, because who wants to socialize on zoom. With the most important part of the conferences and the social part is not me. Sorry, it's not the lecture.

Is it people you meet? That's where you learn a lot of the stuff of how to do things. The very basic stuff you had to do a lecture with slides, but all these panels that we always have are very rich because then people will tell you their story and we all have different backgrounds and different stories.

So I think that's what I would recommend. And I wouldn't change a thing. I just wish I had done it sooner. So I wouldn't be wouldn't have been so tired. But like I said, you got, you have to hit bottom to be able to look at other things. If you're comfortable in your fee for service employed position, why would you change?

Why would you get out of that? If you, if, sometimes we see it on the Facebook group, right? People describe their job and it's like, why are you trying to get out? Perfect. You have enough control, you have good payment, you will have enough hours that you're off and you have a good lifestyle wide. Why change?

I mean, This is not for everybody. I love it. And we're all evangelizing, but in reality it's, you have to find what's good for you.

It goes back to, we love it because this is what fills our cup, but you're so right

and that doesn't mean, it's a bad thing. It's like, if a patient doesn't join your practice, that's not a bad thing. There's one more person in the world who knows about your practice and who could potentially tell somebody else about your practice.

So it's the same thing. Even if they don't join the movement, they might know somebody who wants to join the movement and potentially someone who will rent your space as you get ready for this.

And you feel the same way. I think when you seem desperate. So when people are starting, if you've, if you are talking to people, try to get them to join, your practice is shows.

And so I learned it early on. I was like, I must be doing something wrong. And then I changed the spiel. I said, okay, This is what I do. And I wouldn't give business cards or anything. It's I just want you to hear it. And then somebody would say, I heard you speak at the, on the radio. Oh, it's you? So then they recognize you.

And then they're like, oh, I heard some people's like years later that they heard about you and it's three years ago, or I heard you at a conference. I'm like, oh my God, that a little bit, it was when patients are ready. It's just when they need something or they have an illness that they see the cracks in the system that then they want to join.

But you, the same way I think with any business you do is you just do the best you can and let them commit. You don't sit and let them come in and you go out there, but you have to give the information first because then people have to trust you with. Sometimes you build up. So I do recommend people get involved with the community.

Cause that's how people will know who you are is not just somebody that can find them on the internet. They've heard about your word of mouth. We say in DPC is how do you get to word of mouth? My word of mouth. It just happens. At some point you hit a critical point where all of a sudden people are just coming in.

You're like, whoa. And that's how I mostly, I I don't advertise at all. And my website says, clearly I'm not taking patients. And I still have people that all the time has to be put on the waiting list, which is really nice to have, because if somebody quits, I can just replace them. If it's a family member, and make an exception, if somebody is like my, whatever, cousin, sister, sibling, whatever is sick and that they can't get in anywhere else.

I, I, do a favor and he's back in karma. Just get out there and people

Thank you so much, Dr. Mont for joining us today.

Thank you for inviting me.

*Transcript generated by AI so please forgive errors.