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Episode 45: Dr. Rosana Lastra (She/Her) of Head2Toe Pediatrics - St. Petersburg, FL

Direct Pediatric Care Doctor

She is wearing a Cat In The Hat Costume
Dr. Rosana Lastra of Head2Toe Pediatrics

Dr. Lastra is founder and lead pediatrician at Head2Toe Pediatrics, a concierge style direct primary care practice. Dr. Lastra is the first and only pediatric direct primary care provider in the Tampa Bay Area to provide house calls for all pediatric health needs. She can handle all pediatric primary care needs that a pediatrician would handle in the office, in the comfort of the family's home. Dr. Lastra is directly accessible to her patients 24/7 providing care that is not only convenient and accessible, but also personalized to the needs of the family.

In today's interview, she shares her story of how she always dreamt of being a pediatrician and how the fee-for-fervice model was not a good fit. She shares about the tools she uses and loves and how she is able to be a pioneer by being the first pediatrician doing virtual care and a house call-only practice for all pediatric needs in the Tampa area. Through her own practice, she is also able to let her creative side shine. Watch the video below to see more on this!

Dr. Lastra chats about her practice... with some of her friends!

Resources Mentioned by Dr. Lastra - Vaccine Declination Document (pdf)




Dr. Rosana Lastra of Head2Toe Pediatrics - St. Petersburg, FL

[00:00:00] Direct primary care is an innovative alternative path to insurance driven healthcare. Typically patients pay their doctor a low monthly membership and in return build a lasting relationship with their doctor and have their doctor available at their fingertips.

[00:00:30] So direct pediatric care, how I like to call it instead of direct primary care to me means that you have direct assessability to me, a board certified pediatrician. This means that when a parent calls, no matter the time they get me, when a parent emails. When they need an appointment, same day, they get me.

[00:00:52] And that means that I get to build a community with my families, for, we get to know each other, and this really [00:01:00] opens a lot of doors in order to be able to learn more about them and what their kids need to keep them healthy. I am Dr. of head-to-toe pediatrics, and this is my direct pediatric care story.

[00:01:23] is founder and lead pediatrician at head to toe pediatrics, a concierge style direct pediatric care practice. Dr. Lustra is the first and only pediatric direct primary care provider in the Tampa bay area to provide house calls for all pediatric health needs. She can handle all pediatric primary care needs that a pediatrician would handle in the office in the comfort of the family.

[00:01:47] Dr. Lustra is directly accessible to her patients, 24 7 providing care that is not only convenient and accessible, but also personalized to the needs of the family. She opened head to toe [00:02:00] pediatrics in October of 2020.

[00:02:12] One of the pictures that you have on your website is the multitude of badges that you have had over the years as a doctor. And I wanted to start with, how did you end up transitioning from corporate medicine to your own direct pediatric care clinic? Yeah, so I will say that it was definitely a process when I was in residency, when I was doing residency, I kind of had the idea that I wanted to open up a clinic or do something that kind of.

[00:02:47] My own, but when I would talk about this to other people, or just commented, I got a lot of that. That's very hard to do. You gotta be really [00:03:00] sure that you want to do that. A lot of private practices are kind of dying and going, you know, being bought off by corporate systems. So I kind of put that aside and I really, what I really liked about my residency was the relationship that I got to build with the patients.

[00:03:16] So during residency, I was like, okay, I'm definitely going to be doing outpatient pediatrics because that's where you really build the relationships. But every time I was at the hospital, I really liked the thrill of the hospital. Like, oh, maybe I should do some hospitalists, but then I was like, no, but I won't get that connection that I feel when I'm in the clinic.

[00:03:36] So I ultimately decided to go outpatient, pediatric route. And I started working at a practice in San Francisco for, uh, a big corporate organization. And I was doing mostly outpatient and I was enjoying it, but I definitely noticed that after the first year, uh, it was different. [00:04:00] Definitely working outpatient as an attending versus a resident is a completely different view, a different perspective.

[00:04:09] I didn't like. Being feeling like I was rushing through appointments, especially like if a patient showed up late, but you're booked into certain time slots. You can't really spend the time to really get to know the families and build that community that I really appreciated during my residency. So I started to think a little bit more about, you know, why I really liked the hospital setting.

[00:04:34] And one of the benefits of a hospital setting is that the patients are at the hospital all the time. So you could spend time with them because he can kind of dictate your time versus having the time being dictated for you. So I started. Um, picking up extra shifts at the hospital and doing Noubar rounds or seeing patients, they also had some like [00:05:00] NICU shifts that I could picked up.

[00:05:01] So I would do those during the weekends or if it was during the holiday and they needed additional help. And I started to really like that. But over time, trying to do that, plus trying to have a clinic, it just, you just have no time for anything else. And I didn't like that lifestyle either for being able to spend time with my husband, talk to my family, take trips.

[00:05:25] So that's when I decided that I was going to quit and try to figure out what I was going to do. I remember I was talking to my husband and it was completely ruined. I was like, I am not feeling really happy. So I think I'm going to quit. And he was like, okay, go ahead and quit. And I think like literally the month right after I was like, I'm quitting.

[00:05:50] So yeah, that was a big moment because I did not have any plans as to what I was going to do other than I was going to quit. So I was like, I'm going to quit and I'm just [00:06:00] going to travel the world and I'm going to take this time to just really enjoy it and figuring out what I'm going to do, but I'm very type a, so I really like having plans.

[00:06:11] So that was really, really, really hard for me to do. And I started applying with locums companies and I applied to a few. And then that's kind of when I went on, like this full-time locum tenens, uh, path. And through doing that, I started to really understand more about what I liked and what I didn't like.

[00:06:33] And I think having all of those experiences together was kind of what led me to understand what I wanted to do for my own practice. So, um, I was doing locums 10. I was traveling off of the United States. That's where that photo of the multiple badges come from. Um, then 20, 20 hits and here comes the, so we can't really travel.

[00:06:55] Although at the beginning, pediatricians weren't very much thought off. So a lot of the [00:07:00] travel assignments got canceled and I actually started. Helping a clinic in the area and I was needed leading someone coverage. And by this point we were now living in St. Petersburg, Florida, because my family lives in Tampa.

[00:07:15] So when we decided to travel, we wanted to move closer to family. So when the pandemic hit, I, um, like I said, some of my trouble assignments got canceled. I wasn't really feeling comfortable with traveling side. Didn't want to continue to apply to more. And I decided to help add this outpatient clinics and why I was helping at this outpatient clinic.

[00:07:38] To see a lot of the struggles that families were having a lot, patients were not coming in. Parents were scared to bring in the kids. They felt unsafe in the clinic setting. And that kind of really opened my eyes into what can we do to provide better care for these families, because we're doing a lot of telemedicine and [00:08:00] transitioning to telemedicine that doesn't cover everything that families need at times.

[00:08:04] And it doesn't help alleviate the stress because there's definitely something different when you're talking to a doctor by telemedicine versus when you're talking to a doctor in person. And now some of these patients, I obviously was a covering provider. So it wasn't that they knew me as a physician. I was just discovering covering provider.

[00:08:26] That's never met and giving them advice for telemedicine. So it's like, how do I know that this is good advice? Or why should I trust this doctor that I've never met? Or I don't even know. In addition to all the stress that I'm feeling because of the pandemic. So, um, a lot of those barriers just kind of started to pop up more and in thinking about ideas, I thought of, well, uh, families are scared to leave the house I don't.

[00:08:56] And then in researching how that could be [00:09:00] possible, then I started to hit a lot of hurdles in terms of insurances don't cover house visits, and we can't do house visits and there are too many patients that we may need to be available in clinic for. So that's not a possibility. And just thinking through all of that, I started to look, yeah.

[00:09:21] I initially, I was like, well, what fits a concierge model where families are paying for the service in addition to like maybe using some of the insurance. So I went down that route and in doing a lot of Google search and posting on some Facebook groups, that's how I learned about CPC and what the drug primary care movement was.

[00:09:41] And then I got connected to a pediatrician's specific Facebook group on DPC, and that was super eye opening after seeing what some other colleagues around the United States telecoms do the DPC model, um, knowing, you know, thinking [00:10:00] back to my residency days when I was like, maybe I do want to open up something on my own, but not knowing what that could look like.

[00:10:06] All the kind of windows or doors started opened. And Alex is like, okay, this is what I'm going to do. And I think I can do this. And so. And you are a pioneer in your area because there's no other physician run pediatric practices in St. Petersburg, is that correct? Yes, that is correct. So I there's no other ones that are doing all house calls for well and sick kids in the area.

[00:10:38] Uh, through the DPC group, I did meet another provider who opened in Pinellas park, which is about 20 to 30 minutes from where I am. But they're in a clinic setting, um, primarily doing in clinic. They do offer some house calls. Uh, I'm not sure of the extent that they're offering their house calls, but, [00:11:00] um, they started, I think shortly right after me.

[00:11:04] And we've actually been communicating back and forth, but, uh, yeah, we didn't know each other until we had. Opened I believe until, or until we were both about to open. I don't recall the timing. Exactly. And with you being, you know, new to the area in terms of bringing the model of home visit direct pediatric care, as well as clinic based direct pediatric care to, to St.

[00:11:34] Petersburg and to the Tampa area, what, what are some common questions that you get from patients when you're educating them about the model? Yeah. Yeah. So I will say for the patients and the families, that app talk to, if it's all been revolved around the house calls. So I haven't really had any questions in terms of the clinic setting, but the most common [00:12:00] question I get is you do house calls and, um, it's been a lot of education.

[00:12:08] A lot of families, of course don't know that it's now a service that's available in the area and they don't understand how it works. So it always starts do you do house calls and then how does that work? And then after that, but do you accept insurance? And that's kind of when then we go into the direct pediatric care model and what that means.

[00:12:32] And I will say, I still feel that families are not fully understanding of maybe some of the benefits that, that direct primary care route can offer, even if they have amazing insurance. So right now, Families that either have insurances with very high deductibles, definitely are like, oh, this is great. And [00:13:00] you do house calls is amazing.

[00:13:01] I'm going to definitely look into this, um, ask for more information, look into the services, families that maybe don't have insurance either become because of a gap in time. Uh, commonly I get like newborns. So like if, um, parent knows that during that first month, it takes that first month for their baby's insurance to kick in.

[00:13:24] And they're just like, I really don't want to deal with the stress of like calling, transferring the shells, figuring out where to go see him or how that insurance works during that. 30 days, I, and not be able to have someone assessable that I can ask questions to. Like, that's just really stressful for me at this time.

[00:13:42] So I just want to go direct primary care out either, you know, for the first year of that baby's life while they federal in, and then kind of figure out the home insurance, that's kind of another family group that I'm seeing that tends to really enjoy that, um, house call model, especially [00:14:00] with the babies.

[00:14:01] They love the idea of not having to take them to a clinic and be exposing them as well. Absolutely. As, as a mom with a three month old, I understand where those parents are coming from completely. So let me just ask you, having heard the families that have become part of your practice, ask these questions.

[00:14:24] I'm, I'm assuming that you. The answers that you were commonly given to educate your patients, to also make the content for your amazing videos that you've made yourself on your website? Yes, I, I definitely have, so I have a few videos that kind of educate on the direct primary care aspect. So I have one specifically that.

[00:14:51] I called direct pediatric care. And it kind of talks about the difference between the insurance model and what do I have to pediatric care is? [00:15:00] So it's great to have it as a reference for some families that are still like, well, I don't quite understand. And then I showed them that, but I will say a lot of it is repetition.

[00:15:08] What I've noticed helps with families and understanding. So they may talk to me and ask me about it and I'll tell them about it. But then I send them the video and I'm like, oh, okay. I, I understand it a little bit more. And then they made then follow me on social media, Instagram or Facebook. And I'll post posts about it every once in a while, I'll put it on the stories actually for the month of March, I'm going to be doing, uh, my topic for the month is going to be about us.

[00:15:38] So I'm going to be doing a lot more about what direct pediatric care is and what benefits families can have from that. So little trickles of information here and there. I've definitely noticed that in the area, there is not a whole lot of education and understanding. It's funny because when I first started promoting my practice, [00:16:00] I would promote it as like, yeah, we do house calls for direct primary care concierge style.

[00:16:06] You should definitely join. And that was not getting me anywhere. But then when I kind of switched to, uh, let me educate you about this. Do you know what direct primary care is? And this is why it could be useful. And by the way, that's what I do when this is my practice that got the conversation going, especially how you were mentioning, you know, families wanting to have.

[00:16:33] Care as much as I can at home, I can easily see how that's possible. Now I want to highlight the other videos that you have on your website. I mean, you did, I was cracking up at your, um, your introduction to your practice video, where you have Mickey and Minnie mouse and your amazing, amazing marionette and the, [00:17:00] when you cut to the scene of, uh, you know, on the floor when the, the toys needed to be picked up at the end of that, I apologize for spoiling it in terms of the ending, but, you know, everybody has to see the video just don't skip to the end.

[00:17:17] Why should from the beginning. That's a great, that's a great, um, and this is a great way to put it. And you know, when, when you listened to Mickey's ear, that that was genius. Can you share about how you go about creating these masterpieces? So I would say my biggest benefit is probably that I want to be lazy when it comes to the videos.

[00:17:42] And by that, what I mean is I like to do a lot of things for the practice, but everything requires time. So I can either spend time learning about all the intricacies of creating perfect [00:18:00] videos, or I can use that time to do other things, to continue to expand the practice and just take the videos as they come out and just make them funny.

[00:18:15] Heart being in the ear was because I couldn't get the marionette to actually move to the place that I wanted her to, to be able to place a stethoscope, to listen to the heart. And then my husband was actually helping me with Nikki sports. He's like, oh, you're listening to my heart's in my ear. We're go with it.

[00:18:37] Like, sure.

[00:18:41] I was like, I do not want to edit the video because editing is going to take so much work. So we got to go with whatever happens first and that's how they become funny. Definitely. You have achieved that because I was cracking up at that video. The graphics that you [00:19:00] use in your videos, like the secret agent video, for example, that one has incredible graphics.

[00:19:06] And do you use a particular video software when you are putting them together? I can tell from some of the. From some of the, um, the titles that it looks like I movies being used. Yes. So I use I movie and they actually have, um, like trailer templates and you just put in photos and videos, but they do everything else for you going back to that, just trying to be lazy part.

[00:19:36] Um, so it was another template to, with those special agent one, you can I say, as you read through the template, it tells you the storyline. So then I was like, oh, that would be a good photo for this part. Or that would be the photo for this part. But then of course it was not like special agent medicine or a doctor.

[00:19:54] So then I had a change. It allows you to change some of the wording. So then I changed some of the wording, but [00:20:00] thankfully there was like a template to follow, which made it easy. And that was great. Now, earlier you mentioned how you transitioned from. Pediatric hospital medicine to working in an outpatient clinic for corporation, and now being a trailblazer and opening your own clinic in St.

[00:20:17] Petersburg in the model that you've developed. I want to ask about your patients in terms of the patients themselves within your pediatric age group, are you seeing more of a certain age and how is growth happening for you? I would say I'm probably seeing more in newborns than I am older kids. The older kids that I've picked up have been either siblings, uh, from the newborns or that they found me through someone who I had talked to because of their newborn.

[00:20:56] So, because I feel that [00:21:00] especially if they're a first time parents, those are the type of families that can really benefit from the service in terms of. Being able to have 24 7 access to me to ask questions because first-time parents always have a lot of questions. So it's a little bit easier to kind of start a conversation with those families.

[00:21:21] And the other reason is they may not have chosen a pediatrician yet. And a lot of pediatricians in the area do not offer, meet and greets, but I offer meet and greets. So it's a great way for families who are looking for meeting rates and they search, or they talk to someone they're like, oh, who's doing meet and greets.

[00:21:40] That kind of sets me apart and sense. And that's what kind of in targeting that group, because you opened in October of 2020, how do the meet and greets go? I'm assuming virtual. Yes. So all of our meet and greets are virtual because it also allows [00:22:00] a way for kind of us to. Communicate with each other, see each other virtually before we're going to their home to do a meet and greet post pandemic.

[00:22:10] I think that would probably still continue them virtual, maybe consider doing some like group meeting greets with smaller groups in a central location, but we'll see where that goes. As part of your practice right now, you continue to do newborn rounds in the hospital, correct? Yes. So I actually that's my son, so I'm actually a pediatric hospitalist for an area hospital, and that is aside and unrelated to my direct primary care.

[00:22:50] When I was doing the locums work, I realized that I really liked working in more of like community hospital setting, where you're [00:23:00] kind of on an on-call basis where you go in and see your patients, and I'm here just on call. So it's that same setup, which works wonderful for me, especially with growing my DPC practice, because I only have to go to the hospital, see the patients that I have for the day.

[00:23:16] And then I leave. I'm not like on a shift schedule where I have to be there a certain number of hours, and that has been very nice. It also allows me to keep up my skillsets. Um, and I feel like it also gives me. A better understanding that, or to be able to counsel the families, I guess your child does have to go to the hospital knowing kind of both settings and being able to educate them on what to expect or being able to say, you know, what this really needs to be seen at the hospital.

[00:23:44] And what about for newborns? Like you mentioned some don't have a pediatrician yet when they are discharged. How do you connect with families after a baby's born, if you were in, for [00:24:00] instance, not at the hospital while they were born or if there was a home delivery. So the families that I see at the hospital are not families that are typically send to my practice or I'm like, Or I, I don't really gather them much from the hospital because most at the hospital that I work, there is a lot of, you know, everybody has very good insurance or they may be on Medicaid.

[00:24:28] I get a lot of Medicaid patients. And as part of my DPC model, I, because I still work at the hospital, I can't decline my Medicaid privileges. So I actually cannot see Medicaid patients. So because of that, I don't really promote much of myself when I'm at the hospital. I just kind of have conversations with the family.

[00:24:47] I don't want them also to feel like I'm encouraging them to like choose me as their pediatrician. So I'm more so educate them on things or qualities that they need to look for a [00:25:00] pediatrician or to know how to choose the right pediatrician for them. And I. To take it as I ask them, like, what do you want in a pediatrician, or what's really important to you?

[00:25:12] And then I make the recommendations on what they say, if it's someone that I know, or if I'm, if I may be a good fit, but I usually try not to talk about myself much. If I would say, if families like me, they usually remember my name and they Google me. And then that's more so how they find out about me. Um, for whole numbers, I have, uh, connections with a few midwives in the area I've talked to that I personally know that I trust that I know their methods, that we can easily communicate back and forth when there may be a concern or an issue or where, like, you know, this family is probably better suited at a hospital, or these are some concerns that I have.

[00:25:54] If the family is doing home birth, these are things that I want to make sure we're kind [00:26:00] of checking off. Having that communication makes us feel a little bit better about patients who I see who come from home births. But the patients that I guess from home births that I accept are from those midwives that I do have a connection with and that we have a personal relationship.

[00:26:21] And I would think that would help also, in terms of just knowing more about prenatal care for the, for the child. Yes. So it helps because we're, instead of like contacting me after the baby's born, hearing them out about them during the time, maybe like a month or even two before their expected due date.

[00:26:42] So. If things come up, for example, something that we may frequently see is GBS. If a mom is DBS positive and the parent family may not, may be considering not doing antibiotics or, um, things like that, then work, I'm able [00:27:00] to talk to them and we kind of address some of those concerns so that parents have evidence-based information and all of the information that they can have in order to make those decisions for their children.

[00:27:12] With that said, I'm assuming that parents will listen to you differently, especially if they know that they can follow with you after the child's born. And they're not having to, to just take a, a one-off opinion of a doctor that they don't really know exactly. So it just helps them building that relationship.

[00:27:33] And it also helps. They obviously trust their midwife a lot. It's someone that they chose to go through that journey with and knowing that me and those midwives can also have like a clear communication and we're able to discuss when we have differences and dumb, seeing bad also helps to build that relationship in that situation where you're [00:28:00] discussing a patient's case with a midwife, do you tend to keep it general so that you're not at all, you know, getting close to, to HIPAA issue, we would only.

[00:28:13] So those scenarios are only with patients that have already chosen to take me as their pediatrician and we sign a contract, but before the baby is born, I, we do keep conversations general because I don't have a patient yet. So it's more guidance and. Places where you could look for more information. And this has been my experience, but yes, it's not a patient doctor relationship until the pain until the baby is born.

[00:28:43] What a different space to be. And I had never thought about that until, you know, as you're talking about the relationship that you have with midwives and the families and that, and how that all works together. And I feel like, you know, some doctors will probably be like, oh no, I don't want to like talk to them before or [00:29:00] anything like that.

[00:29:01] But there are some life-saving things that could happen. And if parents just feel comfortable talking to someone there may not even be looking for like a medical advice is talking to someone who they feel comfortable with. It could really change like a big example of vitamin K. You know, if a family's on the side of whether they want to use the vitamin care now.

[00:29:20] Whereas if I'm waiting for me to come in. After the baby's born, kind of all those decisions have already been made. So that's why I have enjoyed being able to have those discussions. And another great example is earlier this week I was talking to a midwife, which we've become friends and it was just random conversation, not even patient related, but you know, she's like, Hey, like I want to know more about the newborn screen.

[00:29:45] Can, can you tell me a little bit more about that? So also being able to have this kind of discussions with these providers, um, where you could communicate about all those things, but then I feel ultimately who's helping the patient [00:30:00] and you're, I can imagine the impact that you're making, not only for the kids, but also for the community, because as we're very aware of, you know, there's a lot of information out there that's not correct or not up to date.

[00:30:14] So the idea that you're putting yourself out there in the community at all stages of a child's life, you know, in utero, uh, when they're newborn and, and also. Talking with these midwives who are taking care of families at different stages as well. So I think that's, that's really powerful that you're, that you're really effecting potentially generating.

[00:30:36] It's a lot better to practice in this because then I'm not like I don't have to be, oh, I can't do this because of that. Or you can't do this because the group didn't let me do it or I can't be out on my own. So it's a lot more fulfilling. When you talk about doing on your own, one of the things that a lot of people are gun shy about in terms of [00:31:00] deciding to actually jump into DPC is the 24 7 call.

[00:31:04] So how has that been for you as a solo practitioner doing pediatric care? So it has actually not been bad at all. I've been used to the twenty four seven call during the locums work. When I would pick up some shifts like at the community hospitals, like I mentioned, or it would be maybe on a seven to 10 day stent on call.

[00:31:23] And I got called there a lot more. I can call now. Um, I actually knock on wood. Haven't had a family call me in the middle of the night and I attribute that because of the relationship that we're able to build, even like now, when I tell some of my families like, oh no, we're not going to call you at two in the morning and wake you up for that.

[00:31:42] You need to sleep. So I'm like, oh thank you. But you can call me, you know, like call me if you need to. But I think the fact that they know that if they. They're going to get an answer is huge, right? Like I think parents stress when their child is sick at 2:00 AM in the morning. And they [00:32:00] know that if they call they're going to get an answering service and they may not get a reply or they may get to a nursing line, who's going to ask a bajillion questions, tell them to go to the ER.

[00:32:11] So they're like, you know, I'm just going to go to the ER, because I don't know what to do right now at 2:00 AM in the morning, versus my families are like, whoa, we know Dr. Lastro is going to answer. So is this I think when you bring down that stress level of being like, I'm not gonna be able to get ahold of anyone right now.

[00:32:28] I think bringing that down then it's then they're like, well, does this really need to be called in right now? Let me think about this. And then it's like, you know, it probably does. Then they know they can call me and I could be like, yeah, that needs to go to the ER or not. Or they may be like, you know, this can actually wait till 6:00 AM in the morning because I know again, Dr.

[00:32:46] Lustra is going to answer at that time. It's not going be. Waiting days to get an appointment, to get my concern addressed. So I think taking away the stress factor really helps in not getting [00:33:00] those 2:00 AM calls. And also my visits are not 15 minutes. My visits are an hour to two hours, depending on how long the family needs me to be there.

[00:33:09] We do. In-depth developmental evaluations. We answer all of their questions. I, I actually educate them. It's not like here's your handout and make sure fever of this call, funny breathing like this call, or, you know, it's not that fast. Like I can actually spend the time to like, well, this is what we look at.

[00:33:29] This is the fever. This is how you take a temperature on your baby. And this is when you would want to take the temperature on your baby. So we can actually, I can actually educate better. And when parents feel. Like they know what to do, or they know what they're looking for. They feel more empowered about their child's health care.

[00:33:50] And I think having that also makes them feel better about knowing that they can handle some things. And then they may [00:34:00] not necessarily need to call me at 2:00 AM in the morning for some smaller issues. Just thinking back to the days when I was a first time, mom, you know, the, the medical brain just completely shuts off when you're an exhausted parent, but.

[00:34:15] Um, the idea that just, just thinking back into that space of, oh my goodness. I I've learned about this in books, but I don't actually know what to do. And to then think about a parent who is having those same feelings without any medical training, potentially. I, I can just imagine how wonderful of an experience that is for them to just be able to pick up the phone whenever they need you, and to be able to get an answer right away.

[00:34:43] Um, I think that is just, it's incredible and it's what everyone deserves, but I'm so glad that you're bringing that service to your families. What EMR are you using for your practice? I was charm health as my EMR and [00:35:00] families can communicate to their, they can email me. I pretty much leave it up to the families.

[00:35:05] And I ask him like, how do you prefer to be contacted? Or how do you prefer to contact me some families. Texts. And that's my way. And I'll do that other times. They're like email that works better for me or their families are like, I wanted to use the EMR all the time. And that's what works for me. And other families are like, I'm in social media.

[00:35:26] So I'll just, if I keep something, I may contact you on social media. So I of course warn the parents that anything outside of the health record is a, not necessarily like a hundred percent secure and it's not HIPAA compliant. So if they're engaging in that way, if it's something more personal or medically, just something that I'd prefer that it goes through the EMR and that I will answer through the EMR and then text them.

[00:35:54] Like I sent you a message through the EMR, check that, or if it's something that it was just [00:36:00] like, Hey, can I reschedule my appointment? Then I answer through whatever method they contact. If a patient's family contacts you through something like social media, like Instagram messenger, do you take like a screenshot or do you reference, Hey, you contacted me in Instagram about XYZ problem before you answer their question in the EMR.

[00:36:23] So you mean like how I document when a family context? Me who? Social media. Yeah. So I will not answer any medical questions for social media. So if I'm ministering to a social media is like, example, like, can I rebook my appointment or a lot? I will say a lot of times to the social media. It's just that families that like to be social, they're just kind of tagging me on their stories and being like, oh my gosh, look how cute this is like holding his bottle now or, you know, stuff like that.

[00:36:50] Um, but I will just say, I will message you through the secure portal as a reply. And then depending on what the [00:37:00] question is or the concern is, then I also document on the EHR. Family contacted. This is what happened. I replied back check. So the patient portal messages for details, communication and marketing purposes, you use Mixmax as a service as well.

[00:37:17] Can you share about your experience with Mixmax and how has, how are you tailoring it for your clinic? So I enjoyed different aspects of Mixmax. One of the ones that I find very helpful is that I can personalize my signature a lot better than I can with any of the other like signature services that I've used.

[00:37:42] So I really like it for that. And it makes it easy to keep it updated. And I also really like it for being able to set up reminders and templates. So some like if I'm onboarding a patient, for example, a lot of that is a lot of the same thing. Like here's the contract, here's the next [00:38:00] steps, et cetera, et cetera.

[00:38:01] So having templates for them. It's super easy on Mixmax to just kind of click on the template and then you can edit it as you needed. So I like it for that. And I also like it for when you're talking to someone and you're like, Hey, let's set up an appointment. It's super easy to put in like your zoom link and like schedule and share your calendar.

[00:38:23] Um, so all of those things have been the things that I've really enjoyed from mixed facts, but I will say the calendar, I use a sparingly. I do like Calendly more for calendar booking. Where should I include as part of my signature on a link? And it just looks prettier on Mixmax line. Having seen one of your emails before, how easy is it for you to put one of your videos in as a signature for your email communication?

[00:38:51] It would be very easy. Yeah. I could put that in. I have one of the videos right now as part of my study. But, um, not one that I made, but [00:39:00] one that I interviewed I could put, like I could upload the YouTube. I want to jump to vaccines because one of the things that you do also offer for your patients is bringing back stations to a patient's home.

[00:39:17] So can you share more about vaccinations, how you obtain them and how you administer vaccines, especially those that might need to be frozen or, uh, kept at a certain temperature? Yeah, so I am very lucky to have some very close friends, were pharmacists in the area who work with amazing pharmacy that are more local pharmacies instead of, you know, bigger pharmacies.

[00:39:41] So they have been super helpful to helping with the vaccination. So currently what I do is they ordered the vaccines from me for anyone who is three. I can send it in as a prescription and they [00:40:00] can get it individually for that patient. And then it's covered through the family's insurance for those who are less than three, because technically like pharmacy laws, they cannot defend to us screen when it's vaccination.

[00:40:14] And then I buy it as a provider from them and they'll, and they sell me in that instance, I have to buy like the box. So they sell me the vaccine and then I missed it. So in that scenario, I could either build the insurance. I tried to do that, but that was a big headache. And I gave up on that. I was like, this is not going to work.

[00:40:38] So I have just been kicking that cough myself and I have not been charging the family for that. But, um, I know with times that's a very expensive cost and I'm not sure. How that would transition on. So I heard about a lot of people that use VaxCare and VaxCare is a company [00:41:00] that kind of sets you up for vaccines in your clinics.

[00:41:05] So they give you the equipment, they provide you with the vaccine and they do the insurance billing. So a lot of the issue that I've had with insurance, dealing with PPC, at least for the state of Florida. And the insurances that I've tried to contact is that they do not contract with direct primary care doctors, even not even as I did network providers.

[00:41:28] So that was a little bit of a roadblock, but with best care, they are the ones that would be doing insurance billing. We'll be able to have a family insurance be processed to be able to for the vaccines through the insurance. So I actually just got approved this week, which I am super excited about, um, because it will really help with that, that from the zero to three lessons, there'll be studying.

[00:41:52] For me where I am, I'll actually be able to just do that for everybody to access care. So my pharmacy friends have kept [00:42:00] the term vaccines that I bought from them. The refrigerator, very tiny, I'm doing all the temperature, logging and monitoring because they already do that for their own vaccines. So, and then the extra nice part, which I'm really going to miss is that they do delivery for the vaccine for me.

[00:42:18] So we coordinate the time and they take care of, you know, continuing that temperature monitoring and keeping them in the environment that they need to be test out before they're administered. So they, we coordinate where I'm going to be, you know what, I'm going to be there with the vaccine and invitations, and that's kind of what I've been doing.

[00:42:37] So in that care, I won't be able to do that because they'll be with me. So I'll have to dig a little bit more about the process for transportation for that. So. I just think about my husband's cousin, who was an ex-pat in Panama for, you know, three, four years. And the, [00:43:00] the way that vaccination is set up there is all, well, the, the way that vaccination was set up for the yellow fever vaccine for kids was all home-based.

[00:43:10] It was not, you go to a clinic and it, at least there, there specific family care was set up through home visits and it wasn't through clinic only visits and or pharmacy only visits. And so I think that, you know, that's, that's wonderful that you've worked, you know, closely. Uh, a, a private pharmacy and your friends who run the pharmacy there, but it's, it just, it's interesting how things are done so differently around the globe and something that's very normal in a place like Panama is, is still foreign.

[00:43:42] I just goes back to the education aspect of your patients in your families. When you get VaxCare on board a hundred percent of the time, what do you envision? Because you're doing a home visit model. What do you envision for your vaccine storage? Like, do you, do you, do, are you [00:44:00] looking at a particular model or product?

[00:44:02] So I am going to start looking this week. Uh, what refrigerator, temperature, monitors, and all those things I was going to be getting. And, um, My pharmacist, friends for some like suggestions and they send to each to look at, and also to the CPC, a split group, a lot of people have posted there for refrigerators.

[00:44:24] I just have to kind of go do some digging on those blog posts to get a better sense of what might work for me. But, um, I think one of the things that I moved forward to able to do when I get back here is being able to set up like strike through vaccine clinics or clinic days where I can offer vaccinations for patients who are also not members, because I've actually been getting quite a few calls on some families who I, you know, we love our pediatrician, but right now with a mimic or concerned about going to the office, but they don't really need [00:45:00] any checkups, but could you do vaccines for us because, um, we don't want to go there to do the vaccine that they're due for.

[00:45:11] So, yeah, so I hope that I'll be able to bridge that gap. Well, Rosana, one of, in relation to home visits, one of the things you had mentioned on a previous interview was you have a toolbox and with you doing home visits, I'm interested to know what is your toolbox and, and what's inside. I have a toolbox it's literally a toolbox, like where you go to rose and those toolboxes there too.

[00:45:38] The tools I use that as my house kids and in there, it has two levels. I actually did a video of what's in my toolbox and it's something like Instagram. I still have to upload it to YouTube, but on my, as two levels. And then I kind of cause the upper level as my like well-visit [00:46:00] stuff in there. And then the second level, or in the lower level is kind of things that I need for school.

[00:46:05] So I have for well visits. I have my, at the skull, my Wayne machine, or like my scale, thanks to get measurements and Heights on the kiddos. I have my emitter, I have my blood pressure monitor. We look, get blood pressure. Uh, I feel like I have to be looking at it to tell you exactly. Um, but everything that you think of, oh, things to do, vision screening, hearing screens.

[00:46:35] My postop Scimitar does, uh, um, hemoglobin screens. I don't have to have the kids to get a hemoglobin screen if I don't need to. I could do that to that. Um, and then I have my gloves mask and sanitizer all those cities in I'm sure I have more in that area. But then in my area, I have all slots that I would need to do stress.

[00:47:00] [00:47:00] RC COVID testing. I have urine urine. Um, I have pickups for non-sterile urine samples and second protein. And I have a well visit. I also have glucose meter to check glucose. I have medication samples and I have anything that I may need my tunnel mode, trainer and allergy medicine, SF friends. When I get my seam and I have a little area kind of in front of the school box that has a little area that you kind of, it's kind of like a little craft classes, so it can clip out.

[00:47:38] And in there, I kind of put things that I use for procedures. So like scissors, pitchers, uh, alcohol swab, extra batteries for when, one of the things that I use, like the scale of battery dies, or like Senator, which also requires batteries. And I have white men. Do you use any appointments [00:48:00] for fab burns, anything like that?

[00:48:01] Dressing. I have math for CPR, for kids, adult size and babies, and came back with Titian, Oxford bids with any reactions to medications or anything like that. Um, just one kind of offenses in emergency, just to feel comfortable that I have that, but knock on wood. I want to cover. And I think those are the main things that I can think of.

[00:48:27] I'm sure. I definitely have more things in there in terms of the education of your patients and their families. How does the home visit allow you to educate differently than you would in an office? I think one of the biggest things is that we're not restricted by time, so we can discuss a lot of things in more detail.

[00:48:49] Uh, one of the other benefits that I'm in their home and in their environment. So I. Direct my education based on things that I'm seeing around them. [00:49:00] So big educational topics that are always discussed or like nutrition and sleep. So with nutrition, when we're talking about nutrition and healthy eating and healthy habits, we can actually like, well, show me what are some things I need on a regular, or go to your pantry and see what fear for trader.

[00:49:19] So you're better able to kind of target and, and understanding where the families I didn't, what their goals are. You can maybe say. You, maybe you can substitute this for this, which could be a healthier or a healthier alternative, but it's just the same as this that you have here. And like a great example of like yogurt.

[00:49:37] Um, people don't really tend to look at nutrition labels for yogurt, but they really differ. And some of them you're going for like the same. I tend to eat like plain yogurt. So I'll look at labels, the plain yogurt. So little things like that, that I'm able to pick up where you're not really changing much when you at least made a small change as toys, healthier lifestyle, um, sleep.

[00:49:59] When it [00:50:00] comes to sleep, I can see what I was doing television in the room, maybe when they consider taking that out or, you know, what is your speech routine and walk me through it. And when they're at the home site, actually, yeah, we both have near to here and I'm going to do we read, you know, I don't see any books that may be something I may recommend or ask when I fly there for us.

[00:50:22] So it just leaves for a whole lot more of discussion. Which ultimately allows for more education. Perfect. With you being a sole practitioner, you mentioned charm earlier. Can you talk in more detail about how you handle medical records and what medical records do you request when you're onboarding a patient?

[00:50:44] Yeah, so I do everything through charm. You add a patient I would in any other medical record, and then it creates a whole chart where you can document, when you do visits, you can make appointments for [00:51:00] the patients, you can upload documents. So in terms of what you can do, you can do almost anything that you can with another EMR.

[00:51:10] It's just, sometimes you may need to do extra steps or you may need to do it in a different way or. Something may be reporting the different minutes, for example, with like the growth chart. Um, so in terms of that, there hasn't been much of a change. What I do when I onboard a patient is I start with an agreement.

[00:51:28] So that agreement is spent for them to be able to sign once that's signed, then I have the few forms of like patient records. So I call it like, you know, new patient form that I sent to them. And that does things like the privacy policy that they have to read through telemedicine consent, uh, in the state of Florida, you require pelvic exam consent of females, even the baby.

[00:51:55] So it has that form in there, um, to give them an idea of the one that helped me not drink [00:52:00] and also to have a main form, it's a chart. And it has, um, kinda like a who they want to add on the chart as like a person. I can move this information too, but I always recommend like if grandparents are involved at the, at the grandparents, um, to that, and those are like the main onboarding document that I do, then once I onboard a patient, I'll do like a video visit where we kind of go through all the medical history and I history and social history.

[00:52:37] And then depending from what I gather there, then we do kind of medical release for willing to need information from I've had a lot of newborns. So there hasn't been a lot of medical, the the hospital twice, which are very easy to get. And for the older patients, most of them are relatively healthy, but some that have seen [00:53:00] providers, then I just have them fill out a medical release for me to be able to get those records back.

[00:53:06] And then I use Doximity or fasting. So it's still HIPAA compliant. So it's one separate school there. Then I just upload them onto the EMR. That's an interesting way that you're approaching medical records because that is something that can be overwhelming if you're getting, you know, 13 years of random records from a patient when they're onboarding, I mean, in your case, you're doing pediatric care.

[00:53:32] So that wouldn't be as much of an issue compared to someone who's doing adult medicine. But, um, I like, I, I think that that's a great idea to do a targeted approach. I talk with them about their family history, about their social and medical history, and then get information specifically about those parts of their healthcare.

[00:53:54] Yeah, I think it's, what's called, I will say, of course I've had a lot of points, [00:54:00] but at least the families that I've had is very well informed. They're very proactive. So they know your child's medical history. Like to the point, they can even tell you like the last shot they got when they got it. I haven't had a family has been like, you know, I don't remember.

[00:54:18] I don't know. No, they haven't had any issues. Like some of the families, like even things, exams, tests that they've done that either kept a record of it as well. So then I'm like, oh, say that called me when I told I want to see that. And all of a sudden I need to upload it into the chart. So I think I leave families that are geared towards the DPC model are looking for higher level of care and the managing higher level of care.

[00:54:45] So they tend to be more proactive at least from what I've noticed right now. So it kind of helps with the whole medical record aspect of it. Very interesting. And I'm sure that that information is helpful for others who are again, [00:55:00] contemplating this type of model. So thank you for sharing that. We've, we've touched on how you.

[00:55:06] Are really building in that early education by interacting with families prior to babies, even being born and working with midwives as well in your community. How do you handle vaccination? Hesitancy? I am open to discussing with the families who are and it's, I encouraged to do a meet and greet. I say a big part is having a pediatrician that you can trust that you can communicate with.

[00:55:34] So a lot of the times that is something that we discussed during the angry, and I am very open with the families and letting them know that I am pro-vaccine. I also do not like to push my views. I like to understand where families are from where they're coming from. Families have different reasons for being where they are at that time.

[00:55:58] Um, [00:56:00] I can tell you if someone has been ill and sick and hospitalized, I have not appreciated when a provider. Told me, like he was going to do this best for you. So I know that if, you know, that's the language that people are doing, it's automatically like puts a roadblock, right? So like your RN has ascends and you're like, well, I don't want to talk to that person.

[00:56:21] Like, they're already telling me what to do. Right. So I don't think that that is the right way to approach things. So I like to keep an open communication. And I like to have that be a discussion from the very beginning during the meeting, because if it's a family where like, you know, we can't even talk about this because he's fighting back and forth and probably not going to be a good match for you.

[00:56:42] But if it's a family, that's like, oh, I, I appreciate your views and understand your views. Um, I want to learn more and I'm like, well, I would love to learn more about what you have your set of views. And we can have those complicated and difficult discussions on that as a family. And [00:57:00] I do onboard because I feel.

[00:57:04] Having that communication, having someone that they can trust being open both ways. Um, they're obviously wanting to have a pediatrician. They don't want their child to be without a pediatrician. So I think that keeping that communication open is the biggest thing for me. And for those families who do ultimately choose to not vaccinate, according to the recommended guidelines, do you have them fill out some kind of form that acknowledges the risks that they're taking?

[00:57:37] If they choose to not vaccinate, I haven't had any families that are like completely not wanting to do and next or whatnot, I've had some families that have discussed doing, like, I want to talk about alternative schedule or I've had some families that are like, you don't have concerns and want to talk about it, but then they ultimately choose to follow the AP [00:58:00] schedule.

[00:58:00] So. I have not crossed that bridge yet. I'm not sure how I'm going to handle that. I think I like the form on immunized org for choosing not to vaccinate over the one on the AAP in terms of the language. So I would like me to using that, but I have not crossed that bridge yet. So I don't know. I like, again, going back to, like, I like to understand where the family is at.

[00:58:29] I think that if a family comes to me, like, we're, you know, so we have discussions when they're like, we are not going to immunize. I don't know if like long-term, we may be the best match depending on, you know, how that communication goes. So I'd say that's a difficult question to answer at the moment based on where things are, right.

[00:58:55] You did a great job answering that. I think it's very fair. I, um, [00:59:00] I, what I recall from the last time I looked at the AAP, uh, version of the P Declan declination form was very, it was very eyeopening because they don't anyway. You're like, you know, I don't know for me, I'm like, okay, I could see why something was not like it when they're signing that.

[00:59:22] So that's why I liked the one from any nice bed or the language on the immunized federal or more. Yeah. I, and I, I'm not to make excuses for the system, but it's interesting because it's almost like that a P form is the declaration form is, is geared towards the pediatrician who doesn't have more than 15 minutes.

[00:59:44] Max is going to see 30 patients in the day. And that's something that. You know, covers all legal bases, but it can be administered by a nurse or somebody who's not a physician. Yeah, exactly. That's why I'm like, so what I actually do right [01:00:00] now for my patients is that I have the vis sheet and I go through those with the parents.

[01:00:10] It takes about 30 minutes to an hour, depending on the family and what questions they have, or we go through each one of those, each one of those vaccines. We talk about the pros. We talk about the cons. We talk about pros and cons. That may also not be listed on worms. And I have like, at the end of it, I laminated them.

[01:00:32] And then I, I put my, um, reviewed by Dr. Last straw on, and then I have some data and then we sign it and they do that with everybody. So I don't know if maybe at some point I may just see that where it's like, you know, You are discussing this, but I do that right now, even with families for vaccinating, so that we're, that's kind of like a forcing function for me as well, to make sure that I'm properly educating them on everything.

[01:00:58] When you talk [01:01:00] about the VAs sheets and reviewing those with patients, you also have your own handouts that you've created. Can you touch on these handouts and how you use them with families? Yeah, so I create different anticipatory guidance, handouts that I give to the family, and it also puts their, like their weight, their measurements for that visit.

[01:01:20] And if they are getting invested in that, I seems that they're giving and where they are getting those vaccines as well. So that families know what went, where, again, going back to Emily that I tend to see a little bit more educated. And if there's anything like, oh, it got red in this area and they're messaging me, we could be a little bit more like, oh yes, That was that went on there.

[01:01:45] And that's a common reaction that you can get with a new tab. So this is vested or, yeah, that was macaque. Hold on one, turn. It tends to hurt a little bit more. I feel like, you know, they kinda like touch this side hurts and [01:02:00] mind, you know, things like that, that they may be concerned about. I'm like, oh yeah, that's the one that we did there.

[01:02:04] Remember we have it on the sheet. So I also actually put a magnet on the back of it. They can put it on their refrigerator and, um, and it also has some developmental milestones, or we look at that they can, that we check off during the visit together if the child's meeting them. And I actually take a photo of that.

[01:02:23] And I also load that into the EMR as the end of the story Vita and all that I'm passing out. And a lot of it is from AEP guidelines on that as well. When I add the CDC elements to look out for, and it gives just the. A more fun way to let that I try to make it feel. And again, coming from a mom's perspective, you know, I, I actually, um, I think that's really smart because when you're so overwhelmed with everything that is required of a parent to take care of a baby, especially a newborn, having something that's [01:03:00] very, uh, colorful, easy to read.

[01:03:03] And that is that, you know, is, has come from your physician, I think is, is you're, you're bringing a lot of value to your patients and their families by, by providing this type of handout. Yeah. I've never liked getting the multiple black and white pages with just loaded up information. Like this is how you need to take care of me here.

[01:03:25] And fact I'm like, oh my gosh, this is too much. It's overwhelming. I try to just keep it a one sheet fun, colorful, put it in your fridge. So was always successful. And it also has, I also put on it like emergency numbers. So like poison control, number, my number for them to contact me like overnight, if they need to get hold of me and those little details.

[01:03:48] So like, if they're like, oh my gosh, my kids follow something and go, I call it like already there. And they're like, oh wait, that's us number. So like, they can just kind of reference that and have, I [01:04:00] mean, for something that may be answered to there absolutely. As these newborns grow older and as your practice has more teenagers, what is the plan?

[01:04:13] If a patient is graduating from your practice to an adult medicine doctor. So there are some adult CTC doctors in the area, so they definitely want to stay within the PTC model. I have some connections that I can refer them to. If they're wanting to kind of transition back to the insurance based model, I.

[01:04:36] Half my doctor so we can refer them to, or, um, I would start to develop like when the time came. So kind of taking a few steps back currently with the kids that I have, I think of like, what are you doing? Like ENT, allergy germs. Those are like typical things. And you always have questions on for kids or [01:05:00] babies.

[01:05:00] So I've developed relationships with providers that I know that I can communicate with that. I can text that if I send a patient they'll report back to me or we'll have that kind of communication. So for example, I had a baby that I had to send to an eye doctor, and I had already developed that connection with the eye doctor and I messaged them directly like, yeah, my office will contact and make an appointment.

[01:05:23] So it's not like the families had to wait for a referral, figuring out what their insurance, oh, who do I need to call? That's covered with this to go see blah, blah. Right. Like the office is calling them, like when can we book you in what time slot we have available? And if they want to use their insurance, they can certainly use their insurance because there's not a lot of specialists in the area that are DBC.

[01:05:46] I don't think there are any, so they're obviously assessing insurance, but being able to build that relationship from provider to provider also benefits the patients. So it would be kind of the same going to the teenagers when I have those patients. [01:06:00] And I would work on building those relationships with providers that they would need in order to be able to have that be as seamless as possible.

[01:06:10] Looking into your toolbox specifically, is there any tool in there or any other tech that you might not have mentioned already that you use in love? Yes. So I have, I believe it's called the rainbow from McAfee. And is the finger Paul's tax Senator, or I could do the rap and a little babies and you put it on just like the last seminar technical talks Senator, but then you have to wait for the light to get all the way to the greens.

[01:06:40] And then once you hear the beep and go across the green, you hit this button and then it gives you your hemoglobin level. And so that I like to use, if it's a patient who is very, very scared of needles. So [01:07:00] if it's any screening work or I'm concerned, I definitely prefer to go for blood work routes. Um, but if it's a patient with.

[01:07:08] A picky eater that parents are really concerned. And like I really concerned they have, or something like that. I may not be as concerned based on the physical exam or other things that I gather. That's a tool that I can use to help reassure parents. Um, if it is a patient again, maybe an autistic patient or someone who's just very hard with pokes, very difficult.

[01:07:28] That could be a way that we could start with that. And if there's any concerns that I can know now, we definitely need to get the blood work or just kind of have it as a second one. So I really like the flexibility that, that gives me to be able to kind of expand a little bit further on what I can do with it.

[01:07:47] And do you have a similar tool for Billy checks? So I currently do not, but I would hope that I can get as a leader, uh, at some point. [01:08:00] Um, I would love to have that. What I currently do is I have, um, Spiders in the area that are full autonomous as part of a company. And they will go out to the family's home and do any blood draws that I need or anything like that for families.

[01:08:18] So I include that one home visit for blood draws, part of membership fees as well, that families get that they don't have to take that if they need anything. In addition, for any testing that we're doing or anything like that, then there's a charge to have them continue to come out to the home. Or the family can just go training lab and get it done for those doctors who are considering leaving fee for service or who are looking to start in a direct pediatric care model, what would you advise them?

[01:08:51] I would say, um, that first they should do most in the area where they're asked to see if there's anybody else already doing [01:09:00] it and talking to them. I found from the Facebook group that I'm a part of everybody. Very welcoming and very open to discuss things in this community about ways we can help each other out barriers.

[01:09:14] People haven't countered all this. So definitely reaching out to people who are doing it and talking to them about it. Um, that definitely helped me. I would see that as number one. And then number two, you in two now focused on much on the logistics of what you need to do to get it done and overwhelm yourself so much that then you're like, I can't do it because I have to do this and this and that or more.

[01:09:43] So take a leap of faith. If it's something that you truly want to consider, and you may not have everything to start with, but start somewhere and things will come. And the fact that you started to kind of like, you know, really meet her. I don't have the meter right now, so, [01:10:00] but that didn't prevent me from opening.

[01:10:01] Right. So things will come as your practice, right? Which is kind of nice to see that you are able to start some potentially very little if you're doing home visits, because you don't have like a clinic setting, um, or other additional expenses that come from a clinic setting. Um, but you can continue to grow on that.

[01:10:23] And knowing that you've started something kind of also gives you a push to continue to work towards making it grow. Wonderful. And are there any other additional resources that you like to recommend to others? Um, the DPC Alliance is also another good resource with good information on the left side. I would say that would be another kind of go-to perfect.

[01:10:48] And what's the best way for others to reach out to you? If they have questions after this podcast and send me an email. Dr. Lastro E R L [01:11:00] E S T R a. And I'm sure you can tell us about this on the notes thing you noticed. Um, add head to toe pediatrics and that's was the number two. So had the number two chose pediatrics, and then at the end they cannot.

[01:11:14] So, uh, I'm texting me to social media on Instagram and Facebook. Uh, add head to toe pediatrics again within number two, instead of peel and or visit my website and. Thank you so much shifter Lester for joining us today. Thank you for having so much fun.

[01:11:44] Next week. Look forward to hearing from Dr. Thomas White, Dr. Joshua Carpenter and Dr. Brianna Buchanan of hometown direct care in both Cherryville and Shelby North Carolina. Dr. Carpenter is one of the incredible speakers that will be speaking at the upcoming AFP [01:12:00] DPC summit. Happening virtually this July 16th to 18th.

[01:12:04] Visit DPC For more information also, I will be hosting another free event this upcoming Saturday, July 10th. This time we'll be doing speed, networking and chatting all about DPC. Check out my DPC for more info. And check out the, my DPC story website for podcast swag, support the show, get some swag, all proceeds, go to producing the show.

[01:12:30] If you'd like what you heard today, please leave a review and subscribe wherever you listen to your podcasts, tell your friends do for more information on this episode and much more. Please visit my DPC also for the latest in DPC news. Check out DPC until next week. This is Marielle conception.

*Transcript generated by AI so please excuse errors.

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