Direct Pediatric Care Doctor
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
Immunize.org - 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 wonder