Building Community and Hope: Dr. Isabel Amigues’ Path to Direct Specialty Rheumatology

Maryal Concepcion
12 minutes ago
6 min read

Dr. Isabel Amigues in a pink shirt — Dr. Isabel Amigues

The Direct Primary Care (DPC) movement has swept across the U.S., offering practitioners and patients alike an inspiring model for personalized, value-driven healthcare. But what happens when this ethos is applied not only to primary care, but to specialties—especially those, like rheumatology, plagued by long waits, insurance headaches, and fragmented relationships?In a recent episode of the My DPC Story Podcast, host Dr. Maryal Concepcion sat down with Dr. Isabel Amigues, founder of Unabridged MD in Denver. Dr. Amigues is not only Colorado’s first direct care rheumatologist, but also a physician whose clinical vision was transformed by her own experience as a patient facing stage 4 metastatic breast cancer. Her journey—through Western and Eastern paradigms, international medical systems, and personal crisis—offers rich insight for any practitioner reflecting on their own DPC endeavors.

From Physician to Patient: The Power of Personal Experience

Dr. Amigues’ story is one of resilience and transformation. Diagnosed at age 40 with stage 4 breast cancer, she was forced to confront mortality, trauma, and the meaning of “healing.”As she recounts on the podcast, her initial approach to cancer was intellectual—and somewhat detached. “When it was stage three, I was like, ‘Yeah, whatever.’ And then when it was stage four … then I was like, ‘Okay, you've got my attention.’” The diagnosis coincided with a stereotypical “midlife crisis,” where, despite personal and professional achievements, she felt emptiness and disconnection.

Crucially, Dr. Amigues began to shift her perspective after a chance meeting with a naturopath in France. This practitioner reframed her disease as a “friend with a lesson,” rather than an enemy—a concept which, although foreign to her at the time, became a pivotal point in her recovery. Dr. Amigues immersed herself in meditation, energy healing, visualization, and radical self-care: changing diet, seeking out loving support, and engaging both Western and alternative therapies.“Do not see the cancer as an enemy,” she recounts, “but as a friend here to teach you something. And like any good friend, when the time has come, we leave.”

The implication for DPC clinicians is profound. Personal illness can deepen empathy and recalibrate values, reminding us that patients are more than diagnostic puzzles—they are whole beings experiencing trauma, hope, and transformation.

Reclaiming Physician Autonomy: The Birth of Unabridged MD

This paradigm shift spurred Dr. Amigues to reassess her professional path. While her institution was supportive—even accommodating her desire to reduce patient load and restructure her hours—the system remained fundamentally out of alignment with her philosophy.“It just doesn't work for me anymore,” she reflects, “and that doesn’t mean that I don’t love you and respect you. It’s just not for me.”

After COVID, witnessing widespread provider burnout amplified her resolve. Instead of clinging to burnt-out colleagues or a broken system, she visualized what “the best care” could look like. Together with peers, she mapped out priorities: healing of mind (meditation, visualization), body (evidence-based medicine), and spirit (community).These pillars would become the scaffolding for Unabridged MD, a clinic built around wholeness, autonomy, and deep connection.

For aspiring DPC specialists, Dr. Amigues’s strategy highlights the importance of designing a practice around values first—not just systems or reimbursement models. “I can be the physician I’ve always imagined,” she says, “and I can see the outcome of my patients exactly the way I wanted them to be. So it’s improved my relationships with my patients and improved the relationship I have with my own family and my own community.”

International Training: Lessons from France and America

Dr. Amigues’s transatlantic medical training provided unique clarity into the strengths and weaknesses of different healthcare cultures.In France, medical education is deeply clinical from year two, cultivating continuity of care, close mentoring, and an expectation that trainees listen and build rapport with patients over months, not days. In contrast, her U.S. experience—especially in New York—was marked by fragmented continuity, rushed encounters, and occasional loss of patient dignity.

The clinical rigor from France shaped her expectations:“It drove me crazy when I came to the U.S. … the absence of continuity of care … How do you create rapport? You’re basically talking about a case.”Moreover, cultural and historical mistrust (encountered notably among African American patients in Harlem and Washington Heights) required her to lean on transparency, shared decision-making, and her own outsider perspective for meaningful relationships.

These lessons reinforce a core DPC principle: continuity and relationship are at the heart of quality care. Specialties often struggle with these due to system fragmentation, but direct care models reclaim this ancient physician-patient bond.

Building Unabridged MD: Strategy, Growth, and Community

Unabridged MD’s growth reflects successful execution of Dr. Amigues’s vision.From a handful of patients, her census grew rapidly—close to 300 at the time of the interview—with multiple clinical team members onboard. Importantly, every expansion was driven by her commitment to maintaining excellence: “Every time I see my team starting to fall behind, I’m like, maybe we need to hire someone. … I want the best experience for my patients.”

The practice’s values are reaffirmed weekly for her team: “We are here to show that a different type of care is possible … this goes beyond the patients. We are showing that we are—like, this system works and it’s successful.”

Rather than viewing direct specialty care as “cheap,” Dr. Amigues reframes it as high value:“I’ve had many patients who've told me that coming to the practice has actually saved them thousands of dollars. … But I don’t think that’s the issue—it’s more valuable.”She advocates appropriately valuing physician expertise and time, not underselling it for volume or survival. This is especially relevant as DPC and DSC practices prove their financial viability and demonstrate professional fulfillment beyond what fee-for-service models offer.

The Unabridged MD Philosophy: Holistic, Transparent, and Empowering

Unabridged MD’s very name and logo tell the story: the clinic offers the complete version of care—the whole patient, the whole physician.Dr. Amigues describes weaving together trauma inquiry, social context, and behavioral change with conventional rheumatologic management. For example, she recalls helping a patient identify psycho-social barriers to remission (“My husband would not be happy if I’m in remission”) and working with her to resolve not just inflammation, but life balance.

The logo—a set of interconnected circles, suggesting both unity and forward movement—embodies a philosophy drawn from both Western and Chinese medicine: “When someone is ill, they are losing balance, and your role as a physician is to help them get back into balance … You’re not going back to where you were, you’re actually going to a better place than you ever were.”

This integrative practice philosophy is especially resonant for specialty DPC:

Treat the whole patient, not just the organ or diagnosis.
Empower patients with choice, not obligation.
Cultivate tradition, innovation, and openness to emerging therapies.

Navigating Insurance Barriers: Medications in Direct Specialty Care

One anxiety for specialty DPC practitioners is access—particularly for high-cost medications. Dr. Amigues’s solution involves leveraging a dedicated pharmacist for prior authorizations, maximizing the patient’s insurance benefits (while avoiding direct billing herself), and connecting uninsured patients with pharmaceutical assistance programs.She’s clear: “I know exactly how to get all of my meds approved, and it’s approved. … If a patient has no insurance, I also know how to get the drug company to pay for that medication.”

For oncology and other high-cost specialties considering DPC/DSC, she affirms:“I think this is needed … All doctors need to get out of the insurance system.”

The Future of Direct Specialty Care: Success, Sustainability, and Value

Dr. Amigues is optimistic, even visionary, about the future of DPC and direct specialty care. She sees conventional, insurance-driven healthcare as “burning to the ground”—plagued by chasing reimbursement, physician burnout, and substitution with mid-levels or AI rather than trusted physician guidance.Yet she believes that proving DPC’s success is not just about survival—it’s about thriving. Her benchmark? “If you can pay a physician $500k then your practice is successful. … I will be able to pay a physician … let’s push that envelope!”

Her advice for specialty DPC startups:

Don’t undervalue your services; don’t make them “cheap” or chase volume at the expense of quality.
Hire and grow as soon as needed to protect patient experience and practitioner well-being.
Share your model and results; inspire colleagues in other fields to join you.

Multiple specialty DSC practices are now sprouting in Colorado—infectious disease, pulmonology, rheumatology—showing that the movement is not theoretical but proven in practice.

THE LATEST DPC MAGAZINE IS AVAILABLE NOW!

Integration, Community, and the Path Forward

Unabridged MD is more than a clinic. It is the embodiment of a reflective, visionary, and deeply personal journey—a journey that any DPC clinician, especially those considering specialty care, can learn from.

Dr. Amigues’s message is clear:

Know your values—and have the courage to build your practice around them.
Harness the power of your own lived experience, both personally and professionally.
Treat practice growth as a manifestation of community, relationship, and holistic healing.
Leverage creativity and resourcefulness to overcome access barriers.
Invite the next generation — and your own future self — to see medicine as both fulfilling and sustainable.

For DPC practitioners reflecting on their journey, Unabridged MD proves that boldness, authenticity, and integration are not only possible, but profoundly rewarding.