Direct Primary Care Doctor
Dr. Jennifer Allen is a board-certified family medicine physician and founder of New Freedom Family Medicine. She graduated from Oceania University of Medicine in 2012 and completed her residency training at Mercy Hospital, St. Louis in 2015. Before becoming a physician, she was actually a nurse and family nurse practitioner for 15 years.
She is also a wife, a mother, and a grandmother. Her family is the main reason she wanted to change from traditional insurance-based reimbursement to a Direct Primary Care practice. To reach her goals of being the best doctor, wife, and mom she could be, she needed the flexibility to do medicine her way.
Now with three clinical locations, multiple staff, and solid entrepreneurship skills, she continues to be the physician she always wanted to be.
In this episode, Dr. Jennifer Allen, discusses her journey of opening and managing multiple Direct Primary Care (DPC) practices. Dr. Allen emphasizes the importance of understanding the goals that one wishes to achieve when starting a practice. She talks about how her business grew organically from one practice to three practices, explaining that it is essential to consider the feasibility of opening a new location and the associated costs.
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Transcript*
Direct primary care is an innovative alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DP C Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.
I'm your host, Maryelle Consumption family physician, D P C, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct Primary care.
When I petitioned the board of the hospital to let me outta my contract so I could open my D P C practice, the president of the board of the hospital said that he would eat 40 kinds of crow if this was gonna work. Now I have three locations around 2000 patients and 14 employees. It's all I can do not to send him a box of dead birds.
I'm Dr. Jennifer Allen of New Freedom Family Medicine, and this is my D P C story.
Dr. Jennifer Allen is a board certified family medicine physician and founder of New Freedom Family Medicine. She graduated from Oceania University of Medicine in 2012 and completed her residency training at Mercy Hospital St. Louis in 2015 before becoming a physician. She was actually a nurse and family nurse practitioner for 15 years.
She is also a wife, a mother, and a grandmother. Her family is the main reason she wanted to change from traditional insurance-based reimbursement to a direct primary care practice. To reach her goals of being the best doctor, wife, and mom. She could be. She needed the flexibility to do medicine her way.
Now with three clinical locations, multiple staff, and solid entrepreneurship skills. She continues to be the physician she always wanted to be.
Welcome to the podcast, Dr. Allen. Hey Marielle, thanks for having me. I'm super excited and
I am as well. This is such a treat because I remember, you know, the very first time I met you down in Florida at the deep, at the Nuts and Bolts Summit, and so it's so cool, you know, as we've engaged on social media, as we've, you know, talked with each other in bits and pieces, I am really excited for a longer conversation with you and especially for people to hear your story because just to start off, if in case you did not know, Dr. Allen has three locations now, and that is something that some people are interested in, other people might be thinking about like, how did you even open three places? And so we will cover all of this in today's interview.
Wonderful. Absolutely. So, Another thing that I wanted to highlight is the fact that you were a family nurse practitioner for 15 years before you got your md, and so I would love to hear from your experience as thinking back in your NP days, what was it as a nurse practitioner that you were experiencing that even made you go into seeking a physician's
degree?
Yeah, so, well, I was a nurse first of course, and then a nurse practitioner and all that time totaled about 18 years, about nine and nine. Really? I don't, it's one of those things, should I count the years I was in medical school when I was still a nurse practitioner or not, I never wanted to be a nurse. I always wanted to be a doctor and life kind of got in the way.
I got married young, I had kids young, and when it came time to go to medical school, I sort of had a midlife crisis at like 20 and was like, what if I. Don't wanna be a doctor. What do I do then? So I just didn't like, I didn't take my mcat. And I graduated and went into the working world and did medical research for a year, and slowly was like withering on a vine because living inside of a hood and doing, I did placental research.
That's what I did. So I went over to the hospital every morning and picked up placentas that were delivered the day before. And I went and processed them and we did research on trophoblasts and neurotransmitters and things that crossed the cellular membrane or not. And I'm sure some people would think it was fascinating, but ultimately it was not to me.
So when I looked into what was I gonna do instead, it was gonna take me four more years to be a history teacher or a year to become a nurse. And because I had already, I had a degree already. So I found this program at St. Louis University where I could become a nurse. And so I did that program and became a nurse, and I actually loved being a nurse.
It was great. But once you've wanted to be a doctor, And you sort of reach a pinnacle in nursing, you know, you don't get credit for thinking as a nurse, it's not allowed and you can't make decisions as a nurse. And it just was not satisfying. So recognizing at that time that I didn't think I could go to medical school, then I had babies by that time.
I thought, okay, what could I do that would be better than this? But not that. And being a nurse practitioner was new back then. So this was like 19 96, 97. So I started my master's program and embarked on becoming a nurse practitioner. And when I graduated I got a job in family medicine and was out in the country and it was great.
I thought, this is fantastic. It's the best of both worlds. I get to manage these patients and make decisions and, but I don't have to be the one, you know, with all of the responsibility. So I thought it was okay. Well, again, once you've been a doctor, It's really hard to just say, I'm not the doctor. You know?
And a series of circumstances happened and I had a patient one day, she actually came in all the time and said, when are you gonna finish? When are you gonna finish your degree? And I couldn't get her to understand that being a nurse practitioner was finishing the degree. Right. So, you know, I would try to gloss over these conversations or, you know, redirect her to the task at hand, like our visit.
Right. And it just never worked. And then, so Christmas of 2007, she came into my office. She had some support people that helped her. And she asked me that question again, and I just said, well, this is where I'm at. It's not that I didn't finish. And she said, well, listen, if there is ever a possibility for you to go to medical school, I want you to go and I'll pay for it.
And I was like, what? So. That kind of thing doesn't happen every day. And even right now, like I have chills still from it. I tried every way I could possibly do to turn her down. I was just like, this isn't right. It's not possible. I had three children at the time, newly divorced, trying to run the practice I was in.
My collaborating physician at that time had been killed in a hunting accident and there was nobody else, like his uncle had been the other physician, but he was like 85 and trying to retire. That was my collaborator and I was trying to run this practice and this was a. Tiny town, country medicine. Like I was seeing patients in the ER we're doing like x-rays and minor surgery in our own little surgical suite in the office.
And I mean, it was just like insane. I, and I lived like 35 minutes from that community, so there were times if I had an emergency, I'd have to go back to work at like eight o'clock at night. And so I was essentially being the physician and not a physician. And like I told my mom, I was like, you're never gonna believe what happened.
And she kind of poo-pooed and was like, oh, this can't be real, you know? And so I kind of put it to rest and was like, no, this isn't really what I should do. And then it kept coming up and they called me and they were like, we were totally serious. You know, we want you to do this. So then I thought, okay, well what if I did?
So I started looking around and all of the medical schools around me are traditional four year college programs or, you know, there's nothing creative about that situation. So I saw a friend of mine who had been, she was a nurse practitioner in another town far away, and I hadn't seen her in a long time.
And I saw her in a coffee shop and I just said, Hey, why don't we have lunch together sometime I'll come down to your office. And she said, oh, didn't you know I'm not gonna be in my office? And I was like, why not? What are you doing? She said, I'm in medical school. And I was like, what? Shut the front door.
Right. So she told me all about the program that she was in, and it's called Oceana University of Medicine. It's a program that was created basically to provide a medical education in the South Pacific in a region of the world where there are no medical schools. The closest medical school was like in Australia or New Zealand.
And so we're talking about the little islands like the Solomon Islands and Fiji and Samoa and places like that. They didn't have the ability to educate their people to be doctors, so a benefactor in the United States. She was like, Hey, I wanna make a medical school there. So they did. With partnership with the government of Australia and New Zealand, they formed this medical school in Samoa in the South Pacific.
And they had this program where if you were a nurse practitioner, you could go to school there and use the internet to be in class. And it, it was something that nurse practitioners could do. So I looked into it and they were in the process of getting their accreditation and they were E C F M G certified and all of that.
And I thought this might be something I could do, cuz you didn't have to go there. Like as long as you had a good internet connection and could go to class when they said you had to be in class, you know you could do it. So I was like, Okay, let's just see. I'll apply. Let's just see if this could possibly work.
Right? So I applied and I had some prerequisites to take and I got in and I made a presentation to these people and they were like, yeah, this sounds great. We want you to go to medical school, so we'll pay for it. So she basically paid my tuition and the equivalent of my salary and benefits for four whole years so I could go to medical school.
So it was quite a gift for sure. And then, I mean, this whole thing to me, I hope people don't think I'm hokey when I say, I mean, it was really divinely inspired because I only ever wanted to be a doctor from the time I was three. I remember being called to medicine and. I just knew that I was supposed to be a doctor, and then when life took its different path, I thought, eh, you know, I guess I was wrong.
But then all of this happened and I got into medical school. I was able to do all of my coursework, all of my mod, they call 'em modules. A lot of people have to like do a module and then work or do a module and go somewhere else, or it's not an easy process, and a lot of people are not able to finish the program in the four years that it's supposed to take.
Back then, they didn't have contracts with clinical sites, so I had to leverage all of my contacts here in the St. Louis area and get rotations. Then I had a baby, so I took my step one exam, nine months pregnant, and I mean, there were just all these hurdles in the way. It was just kind of crazy. But I passed my step one exam on my first try.
Yay. It was hard. Then it was time to wait for interviews, right? For a match. And I, because of that baby, I was about 10 weeks off cycle, so I was gonna finish and my program, my school said just apply for match next year. Just wait. But I didn't wanna wait. I wa it was the year where my NP license was going to expire, and I was like, do I re-sit for my exam or do I press forward?
You know, I didn't wanna be both. I was like, I'm committed to be a doctor. That's what I wanna do. So, I'm gonna push forward. So I cold email. Do you know how you can, like when somebody works at a professional organization, you can figure out their email, like first name dot last name at that kind of thing.
So I'm like doing that with the program director where I wanted to go to residency. And of course you're not supposed to do that and the program director's not really supposed to give you advice, you know, outside of the match kind of a thing. But, so I emailed him and I just said, here's my situation. I am off cycle.
I wanna apply to match, but is it gonna hurt my chances? You know, is anybody even gonna look at me because I'm off cycle? And his email back to me was, There's no penalty for trying one sentence. That was it. Not Hello, not Goodbye. I don't even think he signed it. It was just that one sentence and I was like, okay, there's no penalty for trying, so I'm gonna try.
So I applied for Match. Getting all of that stuff from three quarters of the way around the world, all of my certificates, everything was such an amazing challenge. Finishing those clinical rotations. It was really, I look back and I'm like, how did I do that? I had a new baby, three preteen children, otherwise new husband, you know, life in general.
And I didn't get any interviews like it. We were coming down to the wire. I had, my last rotation at school was my OB rotation, and I had saved it because we had to do a rotation in Samoa. And I wanted to do that rotation in Samoa because I knew I would get hands-on experience. And once you've already had four kids, being a medical student in the us, standing in the corner of the room, watching babies be born is not fun, right?
Done that already. So I really wanted to deliver babies. So I was leaving January one and was gonna be gone when Match closed. So if I didn't get any interviews, I was s o l, right? So my step two scores dropped in like, I don't know, December 8th or something. And that day, because my step two scores were stellar, like really high, because I'd already been working as a clinician for so long, that step two was easy.
And so I got my two interviews. Two interviews, all people listening, they're like, oh, I did a hundred interviews. You know, that was not my reality. I had two places I could match to that were within driving distance of my house, and that was gonna have to work. I did have a plan B, like for a four hour radius where I could go and be a resident during the week and maybe come home on the weekends.
That was my fantasy, right? So those two interviews dropped in the same day. My step two scores dropped in, I got interviews and then had my interviews before I left because I was gonna be gone. I mean, it was just, it had to happen on time and had good interviews and, you know, had to wait until match day.
And so, All that. I packed, my suitcases got on an airplane. They changed the international dateline that year, so I actually lost a day like forever in Samoa. They were on the wrong side of the international dateline to do business with Australia and New Zealand, and so they arbitrarily like put a little hook in the international dateline so that Samoa has in the same time zone with.
New Zealand and Australia. That happened the year I went. So they went to bed literally on a Saturday, woke up and it was Monday because of the way that worked and I was in the air when that happened. So I missed a day. I'm a day younger than for real. No, I'm laughing. But that was an incredible experience.
Loved every minute of it. I highly recommend doing medicine in another country because it's quite different than what we do here. So I came home after that experience, delivered lots of babies, got to do C-sections, all kinds of stuff in a, what I call a second world country. It's not really Third world, 1950 United States, and came home and waited for match day and unbelievably matched to my first choice and got to go to residency in St. Louis. And so I'm a alumni of Mercy Family Medicine. It's the second oldest family medicine. Residency, I think, in the country and I'm really proud of that. I loved every minute of it. It was fantastic. So far what we've heard in your story, the thing that I keep thinking about is where there's a will, there's a way, and where that will came from.
It's so cool that your will, your stories will came from not only you and that calling that you had when you were three, but also your patience pushing you. And you know, one of the things that I wanted to ask while you were sharing how determined this patient was to get you finished, quote unquote, was have you talked with her since about what was it that she loved in you, that she believed in you, to the point where, when Dr. Allen is my doctor, someday I will continue to see Dr. Allen because I value her, you know, in this way or that way. Had you guys had that conversation about why she was motivated to, to support you as she did? Yes, I got to ask her. So she was actually quite elderly and I had diagnosed her with a biliary cancer about five years before this happened.
And she was a remarkable woman. Her story in and of itself have a podcast about that sometime, but, so she has since passed away. But yeah, I got to ask her and she said that she felt like she could make more of a difference making me a doctor than building a wing onto the hospital. That's just amazing.
And you know, it's not every day that things happen where we really get ourselves checked into like count your blessings and count the things that really do happen for us that allow us to live authentically. But I think that is just incredible. So let me ask you there, when you had gotten your md, you had this incredible experience in Samoa.
You know, you came back to a place where the time zones were not changing when you were doing your thing as a doctor. What was the journey like there in medicine that made you look for a different way that ended up with new family medicine being your baby? Yeah, so I think it was my fourth year in medical school.
I don't know if it was national conference, something was held in St. Louis and like, I don't know, 2012 and I think that's where it was. I saw Josh Umber speak and he mentioned this thing called direct care and I, it was like, I'm like in this room and I hear this concept and I'm like, oh my God. This is it. These are my people. This is exactly, I was like, duh, this is a no-brainer. Why aren't we all doing this? And so that was where it landed on me. And I had been in healthcare long enough to know what it looked like and to do billing and all of that stuff. And I thought, I can go back to this little town where I have been a nurse practitioner and I can build this direct care practice and make a big difference.
I, I can, and I had the plan to do it as an employed physician. Like I had a whole business plan made up how I was gonna help take care of their population of people that couldn't pay their bills or that wouldn't pay their bills or that needed extra care. The uninsured, you know, this was a little critical access hospital that was losing money hand over fists all the time.
And I thought I can help. Their patients and they really wanted me to come back. Like they wanted me to sign my contract at the end of my intern year to come back. And I told them this. I'm like, yeah, I'll come back, but this is what I wanna do. You know? And I thought since I knew them well, and there's only like four physicians on the staff that I thought I could have lunch with the president of the hospital anytime that I, little me could make a difference.
Right. Well, that's a bunch of bologna, because inside the system, no matter who you are, you know, they live with blinders on and they're like, yeah, okay. Oh, interesting idea. You know, just placating me. So I still at this point think that I can do that. So I go back, I start my practice. I had a partner who, they had hired her after me, but because she wasn't off cycle, she started before me.
And so she came in and sort of had set the tone for everything and not that anything was bad about it. She had been there for two months already, sort of setting the stage and doing things her way. And so I felt like when I came in, I couldn't really do it the way I wanted to, which I mean, it wasn't a bad thing, but it wasn't the same.
And there were all kinds of other things like the the vice president or the assistant director of the hospital or whatever her title is, she would never call me Dr. Allen. And again, I'm not being snooty, but I earned that title and she just acted like we were on a first name basis, you know, all the time.
And which is how she addressed me when I was a nurse practitioner. But I kind of felt like, you know what, I'm not a nurse practitioner. I'm a physician. I earned this. I did the work and you should call me doctor, at least around. Other people who don't know me, you know, it just, all these little things were like needling at me, plus the whole idea of the direct care.
So about six months in, I brought it up. I was like, remember, you know, when I came on board, I said, I really wanted to do this and I feel like now would be a good time to start this. And my plan involved, as I grew the D P C practice, I would basically give them back my salary. They wouldn't have to pay me because the practice would pay me.
And again, they sort of, you know, patted me on the head and said, well, what she said was, Maybe we could try it with our executive staff. Mm-hmm. And see if it would work. And I was like, that's not the intention. You know, that's not how it's supposed to work. It's supposed to be the patients who need more care, the patients who need more time, you know, people who can't afford what the hospital's billing and stuff like that.
And so it just became kind of obvious to me that they didn't care at all. And then like so many people, you know, I was on a guarantee, which was a nice guarantee, and as like the end of my first year was coming up, I was still on guarantee for another whole year. But you know, they give you that report where it says, Hey, this is what we're paying you, this is what we're getting reimbursed.
You're gonna have to see X number of patients more to match your guarantee when you're done. You know? And I was like, it's impossible. These are sick old people with. Hundreds of medications and things, I can't see them any faster than I already see them. It's dangerous and I'm not doing it. And then, you know, spending basically every Sunday, finishing my charts from the week before, I had the naive notion that maybe I could get some comp time for all the time I was spending after hours trying to finish the paperwork.
You know, so just all these little things were chipping away and I had this golden beacon of D P C, you know, in my mind. So when I would have a break, or sometimes on my day off, if I had to go in for something else, I would drive around this very quaint little town called Herman Missouri and look for my ideal.
Where would I put my practice? If I was gonna do this, where would I put it? And there was this gorgeous building on one of the main streets in town, and it's just your quintessential little shop. It has the two, you know, bumped out windows with the door in the middle and of the little side entrance on the side.
And it was just a beautiful building. And I happened to know the, the owner of the building was one of my patients. And I said to him one day, I think I was actually doing stitches on him. And I said, Hey, if you ever wanna sell that building, let me know because I'd be really interested. Right. So you know the things you say, right?
So I said this, it was probably like October, and then February I got this. Blank envelope. Just a plain envelope with my name on it through the window. One day that somebody handed it to me and was like, somebody dropped this off for you. They didn't tell me who. They didn't know what it was. It was licked shut, you know?
So I waited till my lunch break and I opened it and for some reason I was like, tremulous, cuz I didn't know what it was. So I opened it and it was this letter and said, Hey, a while back you said you might be interested in our building, we're getting ready to sell it. We'd like to give you first dibs. And I was like, oh my God.
Oh my god, this could possibly happen, right? This was February. And right then I was like at about this, so we're like 18 months into my contract of a three year contract. And I was like, I'm gonna do this. So I went to the president of the hospital and I said, here's a situation. I wanna do direct care and I wanna do it right here in Herman.
I. And you're not gonna let me do it, so I'm quitting. And so I had to go. So what people don't realize when they're coming out of residency, signing onto a place when you sign a contract, you give them your license. Like you can't moonlight without permission. You can't do anything. And so I had to go to the board and plead my case basically, and say, I want out of my contract, I want my license back.
I don't want you to enforce a non-compete because this is what I wanna do and how can I compete with you? You're a hospital, you know, well, about half the people on the board, maybe two thirds of the people on the board were my patients. So what are they gonna say? You know? Like, no, we don't want Dr. Allen to do this and we're gonna kick her out of town.
I mean, they weren't gonna do that. So they agreed to let me out of my contract. They agreed to let me open up a direct care practice. As long, they said, as long as you don't bill insurance, you know, like, promise I'm not gonna bill insurance. You don't have to worry about that at all. So they said, okay. So from the end of February, first part of March, my, I gave 'em, I guess it was about 60 days, cuz my last day was supposed to be the last, whatever, the last workday of May was that year.
And about the middle of May, they said, okay, we don't need you anymore, you're done. And I think it was because I was telling people where I was going and what I was doing and they were like, Nope. So I was able to buy that building and I left and got all my stuff together, you know, did my opt out and. All of that stuff.
And July 3rd I opened New Freedom Family Medicine. That was 2017.
That is insane. That is just insane. And I love how, you know, in the first part of your story you were talking about how like no, this is the end of my journey. Like I literally have finished my training, I'm a mom, I'm doing my thing, I am a nurse practitioner.
Period. Then once you had, you know, gotten you once, if you had earned your md it was like, you know, this is what I'm going to do. There was no aspect of settling in that. Yeah. In that second part of the story. And so I really think that is so inspirational for people to hear and I was dying laughing when you were like, nah, the bored two thirds of the people were my patients.
Like that is incredible. And that is, so it goes along with a person handing you a letter and even your patient who supported you to go to medical school. It's like, this is so small town. And I love it because that is like, that is my jam is small town communities. And so I just love that. Everybody around you, throughout your story has supported you in this journey.
When you saw, you know, the, this golden light of D P C, what did it mean to you that was different than, you know, the clinic that you had been practicing in if you had stayed in fee for service?
Yeah, so what was so obviously different to me was the ability to do what needs to be done the way it needs to be done and not worry about how it's gonna get paid for really.
I mean, of course you know it's a business and that's probably the second part of my talk is you know how to run a business as D P C. But in my office one day I had a cash pay patient and I had to go to the office manager and say, this person needs a trigger point injection and she has no insurance.
What's it gonna cost her? It took her like 45 minutes to come back with a cost of like $248 and I was like, first of all, this woman was practically destitute. Okay. And I said, you might as well have made it $20,000. She can't pay $248. And so I told my office manager, I said, next time I'm not gonna ask you.
I'm not gonna chart it and I'm not gonna bill the medicine. I'm just gonna take it and stick it in her back. I mean, that's gonna happen because it's two and a half minutes of my time and about a dollar's worth of medication. It was ridiculous. So that was like one nail in the coffin. And then the next nail was a sign, like they hung a sign in the lab and it said something about needing prior authorizations for something on Medicare patients.
And I was like, first of all, that's bologna. You don't need a prior authorization at all. And I'm not gonna let my nurse spend two hours on the phone trying to get one to only be told you don't need one. Right. So I was just like, I can't follow the rules. I, these, the rules are stupid. And I. They should be broken.
Mm-hmm. That's probably my underlying personality trait right there is just don't tell me no and don't tell me what to do those two things because I'm gonna do the opposite. Amen,
sister. Oh my gosh. It's funny because when you get people talking about their experiences, you know, pre dpc, a lot of that feistiness comes out because, you know, we're literally feisty for our patients and for ourselves as you, you know, found easily, you know, just from your experience going into getting, you know, your md, but then also in this short time with your MD and not being able to do D P C right away.
So it's so interesting. Now let me ask you here, because something that you know is happening in most states, nurse practitioners are able to practice independently without physician oversight. So I go back to this patient who was like, I want to continue supporting you and supporting you until you were a doctor.
Did you guys ever talk about like, Why wasn't it okay that you just stayed a nurse practitioner and continued to practice as a clinician in your area? And what is the difference that you see from your experience being an MD versus having a patient choose a clinic that is run by a non-physician model?
Yeah, so I got the opportunity a couple times to explain to her, you know, what it meant and the difference. Let me be clear. I do not support NP independent practice and have been in the fight in Missouri. It's. Of course on the ballot. Again, I'm not against nurse practitioner practice, but I feel like the idea that a person with such a fraction of our education and training can do what I do.
I mean, it's terribly insulting, and they always say, oh, well, in rural medicine we need more providers. Okay, so you're gonna take the most vulnerable populations who have the least support, the least access to specialty care, and give them undereducated undertrained. Healthcare providers. I mean, well that doesn't even make sense.
So I've always found that very insulting. Now I employ nurse practitioners. I have an assistant physician and two nurse practitioners, and I'm probably working on a third. Nurse practitioners absolutely have a role. I cannot do everything, and I have trained them. I have, I give them as much knowledge as I possibly can, and I have also, Precepted nurse practitioners because they're, there just aren't very many medical students that wanna come to Herman Missouri.
But nurse practitioners are all over the place. So when they come to my office to get education and training, I mean, I want them to understand what they don't know. The difference really is the depth and width it comes down to like the differential diagnosis. You know, they're okay with like the top two things.
Like it could be this, it could be that. Okay, but what about the seven other things? That's the difference. It's like the Grand Canyon of knowledge and you don't know what you don't know until you go through this education. You know, it's the difference between, you know, referring to specialists all the time for something that a family physician can do.
When we're allowed to use our education and training, it takes time. And that's the thing, the fault with the system is we're never afforded the time we become referral sources. Because we don't have the time to use our brains. Basically, I think it was Vance Lassey said one time at, I think it, this was the Masterminds maybe back in the beginning of the Masterminds.
He said, if you don't want people to replace you with nurse practitioners, stop acting like a nurse practitioner. And I mean, he is totally right, but it's no, it's not the individual physician's fault, it's the system that they work in. Because I certainly didn't feel like I was able to work at the full extent of my license as an employed physician.
But I, I can do all kinds of things. So I know in the states where nurse practitioners practice independently, you know, it's very contentious and probably because physicians are difficult to mobilize. It will happen in Missouri and I'll have to sort of figure out how to deal with that. But people need to know that.
I mean, it is not the same. They do not give the same care that we give. And, you know, I reflect on my own experience with the population that I live in or the community that I live in. The population is very heavily Medicare by age based, and they have the knowledge that we have the knowledge as physicians mm-hmm.
To be able to work down our differentials. So I, I think that's, again, it's just, it's so uncanny how your journey happened, um, with this patient along the way, pushing you to become a physician, to be able to be the most educated, most trained in. Dealing with 85 to 90% of everyday problems as a physician is taught to do in primary care.
And like you said, as long as they have the time. I appreciate you sharing that because Yeah, you're right in that, you know, the overall trend that I see as you do is that, you know, there's this argument about access, but it's like insurance is not healthcare access is not healthcare when it comes to, you just get access to whatever's there rather than a a time, a relationship that's based on having a relationship with a physician who knows you and who has the time to take care of you.
So I'm sure that there are many people nodding their heads with that. Now, when it comes to the statement that you had this beautiful business plan built out, and like I highlighted earlier, you have multiple locations and as you highlighted, you have multiple people working at New Freedom. And so when it comes to this business plan, how did you go from being.
A nurse than a nurse practitioner, than an MD with no MBA in there to developing this beautiful business plan. And can you tell us what the business plan was at the time? So my initial business plan really, I mean, it was basic math. I mean, it was, here's the practice of medicine, this is what I wanna do if I charge these people X amount of dollars per month.
And using the statistical model of how often they come in and, you know, the cost. I mean, it was just basic math I need. This many patients to make this salary plus maybe pay this person, you know, I, it was just literally that we don't need all this extra stuff necessarily that we are sort of brought up to think that we do.
I mean, these are the tools. I got this right here. I love this. I was just reading something where there was a person who had recently opened up their D P C and they were making a comment that like, oh shucks, the building owner had to come and fix some port of some portion of my clinic today. And I didn't know what to do because they had a patient coming in.
And then I said, wait a minute. I am the boss, so I get to do whatever I want. I'm gonna go do a home visit because it can't be at my clinic. And it's like, yes, that's, that, that is an option. So yeah, it is very interesting when we taken back into what do you need to actually do your job as a doctor? You don't have to have a lot of things.
Uh, you know, when you really truly think about how do you start diagnosing a patient, even the ability to just talk to a patient and get their history is like we're taught. You know, sometimes 80% of what we can gather is literally just by talking to a person, which also requires time. So how did you go from simplifying.
What do I actually need to, you know, start my clinic to then building it out so you, you know, could have the dream space to then create multiple clinic spaces as well as hire multiple people.
So it sort of evolves on its own in a way. It's very organic. I will say this, in the beginning, I absolutely had no idea I would have three practices.
That was not my goal. I was, it was one, one and done. But the lesson in that is when you open your practice, you have to think about what are your goals on the other side. So family time, free time, that kind of stuff. I don't do free time. Well, you'll probably figure that out if you ever know me, I don't rest well.
So I always have to be busy doing something much to the chagrin of my family who probably wishes I had a lot more free time, but, It just, it grew organically and I saw this need and my first office, like I said, is about 35 minutes away from where I live. So that's quite a commute back and forth. And I hired somebody to do some social media for me and she said in passing one day when I talked to people in the community, they really wish you had an office in Washington.
And she didn't say like, oh, you should open one. She just said, people say that. So that got me thinking and I thought, Well, I live in Washington. It sure would be nice to be home sooner, a couple more nights a week. And so that's how the idea for the second location came about. I thought, well, I can just rotate, you know, back and forth.
I have good support staff and let me think about that. So again, it came down to the mathematics, like, can I afford it? So we started, I was doing two things. This was actually kind of funny. So I have a guest house in my building that I bought in Hermann. It's a huge building and. Very quickly on, I had to figure out how do I help this building pay for itself so it's not all on me.
And so I, there was an apartment in the building and I renovated it and it's an Airbnb and that pays the mortgage, which is fantastic. There's space for another one of those, which is like next year's project. But I didn't have the funds like to buy a building in Washington. I didn't want to, didn't wanna do that, although I haven't ruled it out for the future.
But, so I just started looking around for a place like, okay, if I was gonna do Washington, what would I need? Where would it be? And I was, again, I, it's all about the coffee, I'm telling you cuz I was in a coffee shop again this time, and. As a coffee shop I go to all the time and I've been looking all over Washington for a place to rent and just physically looking like, is it in a location I would want to be?
Would people see me there? That kind of thing. And I'm sitting having coffee and I turned and I looked, and right across the street from where I'm having coffee, there's a big sign says for rent. And what was funny about it was the phone number was the Herman phone number. So I was like, okay, that's gotta be a sign, right?
So I called and sure enough it was, they have like 900 square feet in a little strip mall location right there in a busy street. It's easy to describe how to get there. I was like, okay, let's do this. Why not? So at that time I was like, okay, let's do this. Well, then Covid happened. Okay. So we had committed to the lease, started the build out, and then everybody's like, shut down.
Right? And I was like, okay, now. Now what do I do? Well, we weren't shut down my husband's office, he worked for the local system hospital at the time. They're like dead in the water. They can't figure out how to see a patient because they can't bill a patient if they can't see anybody in person. Right. So everybody's talking about telehealth and I literally, this, I'm gonna sound stupid, but I literally had to ask somebody.
I'm like, what is different about the telehealth that they do versus the telehealth that we do? So I think we literally shut our doors for a week. That was it. We just for a week and we did all kinds of stuff on the phone. And then we figured out, you know, we had pe, we saw people in their cars. We, I think I was busier during covid than the, all of the local hospitals combined, because they just didn't wanna see anybody in person.
So we went ahead and opened, I mean, we opened, we even had a grand opening with like in the parking lot, people wearing masks and we didn't serve food. That was the difference. I handed out little potted plants. That was your welcome gift. But, so we opened, and then our growth in Washington was exponential.
And we actually, right now, so that was spring of 2020. Is that when Covid was? Yes, 2020. And now literally next week, we're moving from this 900 square foot PA space to 3000 square feet on the other side of the street. And I ask this because legit, I was in a bank in San Francisco that had a Starbucks.
Literally we inside the bank. So I ask you this because your life is so, you know, blessed by coffee as well. Are you incorporating that coffee shop into your clinic space? Is that part of
that 3000 feet? So n no, not in this one, but in the Herman location we did open a cafe in the back of the building.
That's awesome. When you think about, you know, having things come onto your plate and you know you're open to change versus you are actively going after something. Recently you had, you know, talked about. Goals and setting. So, so there, I wanna ask about how you go from part of you being open to, you know, new things, but also part of you having to set goals for your practice and how have, you know, built a, a an S O P or a template for yourself and your business to be able to set goals no matter what those goals are?
So I, I had a lot of learning to do. So that same marketing person introduced me to a business coach. She was running a special and they did like a, I don't know, some free four hour consultation or something. And so that was about year four into in business. And I, what I said to myself one day was, I never considered the idea of a business coach, but I recognized that I had gone about as far as my own brains and determination could take me, and I needed to know more about business because, you know, you start thinking about, well, what if something happens to me?
What does this just implode? What happens? What happens if I wanna retire? How can I make sure that I am building a legacy and an actual wealth instead of just working myself to death? And one time I had like three employees and then I went to seven, and now I have 14. So, And I probably need three more.
So I'm responsible for those people. So how do I ensure they have longevity? How do I ensure that they're doing the best that they can do? What else can I offer them? And there sort of is this. Flame, for lack of a better description. Like, I didn't know. I liked being an entrepreneur. I love it. I had no idea.
And I have ideas for different businesses all the time. They like come into my head and then, and the way I sort of pay heed to them is I don't listen the first time. Like if an idea comes in, I'm like, oh yeah, that's an idea. Okay, whatever. Well, if it filters back around, then I pay more attention. And when it's, you know, nagging me, then I really sit down and look at it and decide, okay, what's feasible and what isn't.
And so that's how our third location happened because the business coach, they were like, you know, you kind of have this down to a science. It seems like something that is, you could almost franchise it. And I was like, oh, there's this constant dichotomy about pure D P C, like my idea of what this practice is supposed to be for and how it's supposed to be versus.
The more practical business aspect of it, one of the, one of the true features of D P C is that we are selling ourselves. Our patients join our practices because they want us to be their doctor, right? And you lose some of that. I mean, having two locations staffed by other people, that's a big change. And so I had to really look at why am I doing this?
Because I respond really well to that relationship with the patient. They make me feel good, and I know that, and that's a big driver of my whole, like why I get up every day. So I had to figure out my true why. And basically it comes down to I feel like I can make better healthcare. And the way I do that is thinking outside the box.
And it's because I wanna make a difference. And so when I understand that I can do those things. Without it being just me. Like I can teach other people how to do this and I, and we ha you know, we sort of have a standard and that then is where it gets hard. Because I can't control what other people do, so I have to hire people that see my philosophy and see how it's supposed to be done and wanna do it that way.
Also, my staff is, they're funny because we have a lot of very difficult patients, as I'm sure most D P C practices do. We attract the challenges because they don't fit in the system, right? I mean, the system fails them time and time again. So my staff is always like, cut 'em off, cancel 'em. You should fire that person and all.
And I just, it's kind of a joke, but I say, all God's creatures, all God's creatures, that's what we do. So, you know, just like for instance, I have a patient who he takes chronic pain medicine. I do not like prescribing chronic pain medicine. But this is a man, first of all, he's a military veteran. He has horrible P T S D and he is in chronic pain all the time from multiple injuries.
He's missing part of his hand and he's been in car accidents and he was injured in the service. And he is one of those people that it's not difficult to care for him as a person, but it's very difficult for the system to work with him because he has these needs. And when you exist in that kind of system for a long time, you get jaded.
So he is always a little rough around the edges. He doesn't fit in a mold and he gets panicky if he thinks he can't get his medicine because he really isn't. And he is not on a lot, but it is a regular thing he has to have. And so every time he goes to the pharmacy, somebody treats him like a drug addict and every time you know, he tries to make a phone call for a refill.
Somebody treats him like he's being unreasonable or you know, they're counting the days. You know, that kind of thing. And if you meet him on his side where he is in pain and he's been treated like crap. And that's his point of view. That's why he acts like that. It's not because he is a jackass. I mean, maybe he's a jackass, but he's not like that with me.
You know? I mean, we have. Really good conversations and I know his fears and I know what nightmares he has and you know, things like that. Those people need to be taken care of. And I just feel like we're in a unique situation to be able to do that and provide that care that other people don't have the privilege of doing.
When you talk about, you know, you as the physician who has this relationship with patients are coming and from a point of reminding people sometimes, like all God's creatures, all God's creatures, how do you then work that culture of like, Hey, remember though, like, like let's take a step back. Like we know that you know the right in front of you today, interaction is not the best, but zoom out and evaluate the patient as a whole person.
How do you not only find people who have been a good fit for new freedom, but also how do you maintain that culture of like all God's creatures but also. Every person is more than, you know, just one interaction because that's a very hard thing I feel just in our culture, especially in the states these days where things are so polarized over lots of different issues.
But I'd love to hear how you do it, because like you've said, you've grown and you need three more people. So how do you do it? Right? So you talk about it, it's, you have a mission statement, you have a policy and procedure manual. You have a, this is how we do it, and you write it down, you put it in an employee handbook and you refer to it all the time.
And so I tell them, this is a situation. This is our mission and this is how we're gonna do it. And if you don't like it, then you can go work somewhere else. I mean, it sounds easier. Than it is in actuality because you do feel like you're hurting cats all the time and you feel like that people's own personalities certainly get in the way.
I've done a lot of personality work, like all my employees have had a disk inventory. All of them have done the, I think it's called Y dot os, which I just learned about, but we all did it. So I know their personalities and I know my personalities and ID I D S SC on the disc. So I'm very inspirational people, like I am the Pied Piper.
But at the same time I also have a very strong personality. So when, it's funny because it was an accident at first, most of my employees are S'S and so they are supportive. They want to do my bidding basically, for lack of a better description. And that works well to an extent. I have a couple of employees that are high Ds and they come across sometimes very strong, and I have to remind them that people are used to my personality, which is much softer, much more energetic.
I drop that D down most of the time unless I really need it. And so I have to sort of coach them in their interactions sometimes cuz a high D will crush an S if they're not careful. And so we've done a lot of work about that and the Y part of it as well. Boiling it down to, you know, why, what and how for people, why are they in this job?
Why did they seek out new freedom? The reasons are not different than you. The reasons you and I suck this. Sought that out. So keeping that in mind and just bringing it to the forefront. But it's an exercise, it's, it is like an, like, I wish I had an active HR department because you know, the company structure that I try to emulate is literally Chick-fil-A.
I want everybody to say thank you and have a nice day and, you know, greet people and it's something you can count on. I mean, have you ever been to Chick-fil-A and had a bad experience? Probably not. No,
that's like comparing, sorry. But it's like comparing Dutch Brothers coffee to Starbucks. Like they, oh man, I go to Dutch Brothers when I need happy people.
So I totally get that. Yes. So, but it is, it is a constant ongoing challenge that the stuff of, you know, staff and dealing with staff I is a constant challenge. And I am faced, I have some, I do have some issues. I mean, I don't think anybody's a good fire, if you will. What? I don't know what the right word for that, but I have some issues with staff and certain personalities.
That is when I go to my business coach and say, okay, I know I'm weak in this area. I need you to help me coach me through it. And sometimes they just script it. They tell me what to say and that works.
So, And because you've worked with and employed with multiple people over the years, what has made that easier in terms of, you know, parting ways with somebody, if you've had to do that more than once?
Because it's just like opening up a D P C. It's like, we don't know what the heck we're doing. You know, most of us, uh, when we start doing it, we have a lot more guidance nowadays. But what has made that easier? In addition to like your business coach giving you a script sometimes for the audience to hear about.
So you really, this is what has helped me. You really have to keep your vision in mind. And if you're constantly being distracted from that or constantly dealing with a problem over here, if it's not aligned with your vision and the way it needs to be done, then you j you have to cut bait. I mean, you just have to move on.
And one of the people that we've worked with, basically the way he put it was you have to say to that person, I really like, I hired you because. This is the job I wanted you to do, and I really wanna keep you. And so X, Y, Z, this is what I need for you to do. And if you can't do that, then I'm gonna have to let you go.
And to me that was, you know, it's presenting that sort of positive. I hired you for a reason and I wanna keep you, but these are my criteria for that, and I'm letting you know now this is your chance to, you know, meet those criteria. Because what's been going on is not meeting those criteria. And that was really helpful for me.
And then recognizing that if it's not a good fit for me, it's not a good fit for them either, you know? So if it's bothering me, it's bothering them. And so I just believe in giving everybody, everybody should have their. Best opportunity to succeed and keeping somebody on just because, I don't know, because it's painful to not keep them on or you feel like you need them.
That's not really a good answer. I totally hear you. And it highlight, it echoes what other doctors have said, you know, who have shared their stories on the podcast. Dr. Glover, Dr. Alman, who you know, have said can come down to this is the job that has been, you know, put in front of you as a person, as a staff member.
And if the job is not being achieved, that's what needs to happen. And if it's not you, then we have to find someone else to do that job. Cuz the job is what people are hiring for, not necessarily the person, although that is different in some clinics and in some cases, for sure. Mm-hmm. And one of the things that.
You know, I love knowing about your practice in particular is when you talk about, you know, giving a person the space to, to be the best that they can and giving them the opportunity to shine. You have a policy for people if they have a child, that they can bring their kid to work for the, you know, first four months and talk about that.
Because, you know, in the US where we hear people are back, you know, within the first week after having a delivery or whatever the case is. We are not like Australia when it comes to postpartum, you know, like freedoms I guess, or allowances is another way to say it. But how did you even come up with that policy?
It started when my daughter-in-law, Who was my earliest receptionist. She had a baby and I needed the receptionist. And I was like, she's an infant. I mean, she's gonna sit in their pumpkin seat, or you can hold her in your lap and answer the phone. I mean, it was for that timeframe where they're relatively inert little things.
It was easy. It was a no-brainer. And we're, you know, we're family medicine. How could I not support that? So that's how it started. And then one of my nurses had a baby, and same thing. She was able to bring her son to work for about nine months. And when they become a little more mobile and a little more vocal and need a little more attention, it gets hard.
It does, but at least the first four months, it's pretty easy. And of course the staff, all the staff pitch in and pass the baby around and the patients love it. You know, the one of my greatest joys is to see, you know, a really old person, like 98, a hundred years old, you know, holding a newborn. I mean, that's just the coolest thing ever.
So That is so cool. Yeah, it just worked out for us. Right now, my newest nurse practitioner is pregnant and she had, this is her second child, her first baby. She elected not to bring to work, which is fine. I mean, I think she knows her limitations, like she would've been distracted or whatever. And that's great.
It's not for everybody, but she'll be afforded the opportunity to bring this one if she wants. I love
that. I'm laughing a little bit too, because my husband, as of this recording, has recently decided that he's going to join me at Bigtree md. Cool. And we were talking about avatars and he wasn't familiar with the idea of the ideal patient, the ideal customer, the avatar.
And so we were talking about, you know, what the ideal patient of a particular age category needs. And when we got to talking about, you know, his avatar, one of the needs was that I reminded him of is children's pictures. Like they need to see the children's pictures, if not the child themselves, because legit in our community, like when you're talking about just even within your clinic, people helping out.
I mean, that is, I've had so many patients, can I babysit the boys? Can I babysit the boys? So I just, I love that. Like as you said, you know, we're family doctors. That's part of being a family is how can we support everybody, so I love that. Now, when you have found your team members, how did you go about finding people and how do you engage to find more people to join?
So I am a little bit of a chicken when it comes to the unknown. That's funny because I'm totally not like that. I'm like, I'll jump off. It doesn't matter. But as far as people go, Everybody was somebody that I had crossed paths with somehow recommended. The thing that draws me to people is their ability to understand direct primary care and to support that sort of no matter what.
One of my nurses, she calls herself my ride or die bitch. She is D P C all the way. She believes in it 100%. You can't teach that. I can't teach that. You have to be loyal and you have to appreciate the mission. Two of my employees were actually former patients of mine in employed life and they both reached out to me.
Each one of them has a relatively minor disability, but it affected their ability to get worked in a typical work environment. And they, both of them independently, didn't know each other, but both of them contacted me and said, I don't wanna be on disability. I wanna work, I can do things. And basically I was like, okay, this is what I need.
Can you do this? And they were like, yes. And so one of them started as a receptionist and has worked her way into my care coordinator position. So, and I cannot live without her. And she's excellent at her job. She's not a trained medical personnel. She's just a person. But she has a really strong, good personnel.
She gets all our PAs done. She, when I call her care coordinator, because if I send an order, like how many times has it happen? You've sent a referral or an order into the big system and it gets lost, or they ignore it, or you know, your patient doesn't get the appointment that you need. So her job, I send orders, I.
Tell the patient this is what we're doing. And then I send her a task and she follows it up on the back end and make sure they got my order, make sure the patient gets an appointment and then the patient knows all about it. So that's her job. And I love that because that was just born out of necessity.
Too many times I'd check in a patient's chart and I'd be like, Hey, I never got that x-ray. And they're like, oh, I never got told to get it done. You know, that kind of thing. And I'm like, oh. So she helps prevent all those redundancies. My nurses don't like doing prior aths, and she's like, it's her. I. You know, she's like, I got it done.
Woohoo. And I'm like, you need somebody to do that. And then the other person, she is our main receptionist and she has some health issues that limit her ability to like work long days. And she works from home. And so with the blessing of the internet and Spruce, she can answer the phone at home and people think she's sitting at a desk in the office and it's great.
So they are gainfully employed and in the traditional system, they would not have been my other staff, my first nurse, she doesn't work for us anymore. And I like to think it's because I gave her the ability to grow and do something different. And she wanted to be a photographer, so she decided to do that.
And she told me she was scared to death for weeks to tell me that's what she wanted to do. And I was like, sister, if that's your passion, you go do it. But they're all. Loyal to the cause and they have, you know, different skillsets. So I also am not opposed to, like, one of my nurses is she's, you know, like some people aren't supposed to draw blood or start iv.
Some people just aren't good at that and she does it, it's not necessarily her forte, but she does all our welcome calls because she's very detail oriented. So she makes sure that the patients know how to access the portal, that their billing information is in there. She takes their medical history, she does phone triage.
Those are her superpowers. And so that's, you know, her role. And so I move people around when I have a need, I try to figure out, okay, who of my staff. Can fit that role and do a good job at that. And so that's how they've sort of shifted around.
That's awesome. And it leads me into my next question that I wanted to ask. As you learn your staff members' superpowers, how do you then develop workflows to be efficient and to create, you know, workflows like you described? What happens with a task after you see a patient? Yeah,
it's always born out of efficiency. It ki or necessity, I'm sorry, something will happen over and you're like, dog on it.
This is really grinding on me. I don't have time for this. And so I have to step back and look at the process and say, okay, where did this break down? And there's kind of a balance. Because as you grow, there's more places for it to break down. So that's kind of a double edged sword. And sometimes, you know, occasionally I will work on my day off and I'll be alone.
And I love it. I mean, I can see 14 patients and everything gets done, my notes are done, everything's fine. It's just a flow that happens. And I think to myself, why do I pay all these people, you know, I can do this myself. And then I recognize, whoa, that's a fantasy. I cannot, but. You just have to constantly evaluate the situation and be willing to change.
I have a couple of my staff members, they don't like change, like they get physically ill. When I say, okay, we're gonna do it this way, they're like, oh my God, no. Or they're like, my kids, they stopped, my kids used to move furniture for me. I'd be like, Hey, let's rearrange a living room. And then I say, oh no, let's put it back.
So when they got old enough to say no, they're like, no, mom, we're not doing it because you're gonna move it back. So why? So my staff, some of them will be like, okay, are you sure? Because we don't wanna do it this way and then change it back to the other way. You just have to sort of not be afraid to try, I think, because you don't know what the outcome's gonna be.
And I try to envision things like in our third office, I have my nurse practitioner. I. Is up there and she's pretty much by herself most of the time until it's my days to rotate there. So I rotate. Among the three locations, we have kept things very streamlined. We have one phone number, one's spruce number, so people call in and then they get assigned to wherever, whichever location.
We use our portal so everybody can see everything. And at staff meetings we try, like we have the provider, part of the staff meeting where we go through our toughest cases. I make sure everybody knows what my plan is and I try not to change their plans. You know, I try not to micromanage. Sometimes I do, especially if I know the patient very well.
Sometimes they want a little nuance or they need my input, but I tell 'em how I want it. And I sort of let them get there. And when you talk about, you know, that part of your culture and that part of how, you know people are really showing up to the mission of new freedom, one of the things that you had mentioned was that you have an assistant physician.
So this is not a nurse practitioner. You have Dr. Meyer who your assistant physician. So how did you bring her into the mix and how does she work in the fold between the three locations to support the mission? So yeah, for people who don't know what an assistant physician is, Missouri was the first state to create this category of, well, I hate the term mid-level provider, but it, they consider them on par with a nurse practitioner or physician assistant.
And these are medical school graduates who have not gone to residency. So I don't know exactly how it came about in Missouri, and it's really kind of funny because I was morally opposed. To the whole category when I first heard about it, because there's a faction of people who are trying to make the assistant physician a path to licensure, and I still feel that people need a residency.
I mean, that's the difference, you know? So Dr. Meyer in particular also had been a nurse practitioner and she went to medical school in a way, she was inspired by my journey. I think she wanted to be a physician, and she knew I was older when I went. She was like, by golly, I'm gonna do it. And she did. And she graduated.
She has an MD degree, just like any other md, but she was older and there was a series of circumstances in her life that happened and it precluded her ability to go to residency. But now she has a medical education, plus about 30 years of experience. As a nurse practitioner, I mean, what a wealth. Of knowledge and skill and she called me and said, I really want to work and I want to be able to use this knowledge and education and see patients.
And I said, okay. I mean, she's absolutely qualified. There's no reason why. You know, the things we learn in residency, I think solidify our knowledge. They help us because most of us have had residencies in tertiary care centers. We get to know the difference between a sick patient and a well patient, and we can manage acute issues.
It doesn't do a lot, you know, for chronic care management and things like that. I think we learn more of that in on the outside, but just because she didn't have that, didn't mean that she couldn't take care of people and see patients, especially with, you know, with my guidance. So I find her to be a huge asset.
So she staffs our Washington office two days a week, and so she's in Washington when I'm not able to be there. And that is helpful. I don't have enough staff for us to have two healthcare providers in, in every location at every time, but, My goal was that each location would have a full-time person and that I would rotate through.
So as we continue to work toward that, we're about there. So I have a full-time nurse practitioner in the Herman office, and then Donna is part-time in Washington, and Jess Helan is full-time in O'Fallon. I have structured my week so that every Monday I'm in Hermann. And then the rest of the week I rotate through.
So I'm either Herman all week or I do Herman, then Washington or Herman, then Olf, Fallon, and I switch.
Gotcha. And what about in terms of you, how, you mentioned like Washington's growth was exponential. How do you evaluate your practice to say, yep, this is enough number of, number-wise for our patient population so that we can balance everybody with the amount of people on staff?
Yeah, so I've, a couple of times I have closed the panel to new members and it comes down to how I feel I'm doing. Like if I feel like I'm overstressed. Or way behind. Then I'm like, okay, we don't need new patients right now. We did start doing a lot more than just family medicine, so I do a lot of other things.
I do P R P, we do hormone therapy. We do, I have a side business as a sort of a medical wellness clinic, and that's where our hormone stuff goes through. We also do IV nutrition and things like that. I try to keep it as medically oriented as possible. Like people call in all the time and they're asking for things that are even way outside my comfort zone.
I'm like, eh, no, we don't do that. But as I've gone through this journey and have stepped outside of the establishment, I feel like our medical education is tainted by big pharma. I feel like there are resources and knowledge that we are not allowed to know about. And until we step outside and recognize that there are whole institutions of healthcare that are different than what we know and that our patients are seeking out, that's the thing.
They're seeking it out. And so how can I tell somebody that what they're doing is wrong if I don't know anything about it? Because it might not be wrong. And in that quest, I decided I didn't wanna be a tool of big pharma. I needed to find other ways to help people actually be well. During Covid, I started to see that drug is the number one or number two, advise with Synthroid to be the most prescribed medication on the planet for like the last 20 years.
Okay? If that medication was everything, it was cracked up to be. Wouldn't we have made a dent in heart disease by now? Wouldn't we have fixed somebody? And I just don't, prior to me sort of changing my practice a little bit, I wasn't seeing people get better. I was seeing people getting more medications, but I wasn't seeing people actually improve their quality of life.
And I want to improve people's quality of life. So for me, I wanted to figure out how could I do that without causing harm and without being a tool of big pharma. And for me, nutrition. So I'm a member of the Plant Nutrition Project and I feel like the standard American diet is killing us and we need to be whole food plant-based.
And the other thing is hormone deficiency. I feel like a lot of what happens as we go through menopause, Or menopause, depending on if you're male or female. I, those symptoms are real and nobody has a venlafaxine deficiency. So I just feel like we need to be treating people's like the root cause of what's making people sick instead of just throwing band-aids at them.
So that's sort of how my practice has changed and kind of where it's going and how
it's become individualized for your community. Mm-hmm. And represented you as a physician. And you know, I ask there, because like you have done adding multiple things, like you just mentioned, multiple aspects of your clinic, multiple parts of your value proposition, p r p, doing particular ultrasound, you know, doing these things that you didn't necessarily learn in residency.
How do you go about finding, you know, how do I learn more about this? How do I incorporate this into my clinic by finding, you know, good. Educational conferences to go to, or training schools to go to, so to speak. How do you navigate the water so that you are able to bring quality care to your patients?
So really, I mean, asking around and seeking out, I mean, unfortunately some of it's expensive. You know, you have to pay for the training. Doing point of care. Ultrasound came about outta my own curiosity. I like it. I like gadgets. I like technology. The tools are fun. And I can't remember exactly how it happened other than.
I saw the butterfly at a conference and I was like, this is the coolest thing ever. And it hooks to my phone. Holy cow. I mean something as simple as, as a gallbladder ultrasound or ruling out a D V T, you know, things that cost people a fair amount of money, but really don't have to, like, it shouldn't be expensive to, to do that.
Right? And so for my patients, I, I thought I can learn point of care ultrasound and have this really cool gadget and. Use it to make me a better clinician. And I think maybe it was driven by the joint work that I do. Cause I do a lot of joint injections and that again, the quest for how can I do this the best and not use steroids all the time.
That's what drew me to P R P. And so all these things were sort of, you know, interconnected in a way. But you know, you seek out the resources, you find a training program pre covid for point of care ultrasound. There were lots and lots of options post covid, things that you know, changed a little bit cuz nobody was doing any in-group, you know, sessions.
But I've been to, what is it? Y U I, Indiana University of Indianapolis or something like that. They had a program for pocus University of, I think South Carolina had a POCUS program. I went to that and then I went to Gussie or gooey, depending on how you say it. So I've been all over the country doing that.
And then I just started using it. I mean, if you use it every day, It's really useful and I don't charge people for it. It's an extension of my stethoscope. You know, I have a couple of patients who have really bad combined C O P D and heart failure, and I find it incredibly useful to be able to look at the I V C and see are they volume overloaded or is this a C O P D exacerbation, that it really helps, you know, drive a treatment plan, looking at a gallbladder.
And I tell people sometimes, Hey, if I find what I think I'm looking for, you might have to go and do this officially so that the surgeon will operate on you. But you know, I'm good enough at gallbladder anyway to call the surgeon and say, this is what I see. And sometimes they don't have to have. You know, another test, and that's just comes out of experience.
But yeah, you have to do the legwork. So I read a lot and I call, you know, I call friends and I, my next quest is to learn how to do carpal tunnel surgery because we should be able to do that. I know how to do vasectomy now. Vance lassi, train me on that. So I offer that in my clinic. And I think using each other as a community of knowledge, that's where it's at.
That's what we should be doing. Awesome. And as you have brought different aspects to your clinic, to your patients, because of getting more training in, you know, in hormones or point of care ultrasound or whatnot, how have you been able to add tech on to, or, you know, adjust tech like your E M R or like your communications platform so that you can have everything work together?
So the EMR is the eternal challenge, right? So I have used all of the major EMRs. I started with one that is kind of word-based and does all the things. It does billing, it does dispensing, but it didn't do tabs, and I. My brain thinks in a very, you know, you should see my computer there, there's a hundred tabs open on my computer.
And so then I went to a, an older E M R that that is tab based and was very much like the epic that we used, you know, in the hospital. It was similar to that, but it didn't do billing at that time. I think they do billing now. And so in that situation, I actually really liked that E M R I went through a time where I did that e M R plus a system that did billing and then I didn't like that combination.
So then I went back to the newer E M R plus the one that was word-based, and I used the word-based one for my dispensing and billing, but then I had med lists in two different places and that was a nightmare. And we were growing like, You know, a hundred percent a month at that time. I mean, it was just insane.
So I had to do something quickly. So that's when I found my current E M R, which is very colorful and has a lot of tabs and smaller, um, but it does all the things. It's got billing and dispensing and, you know, the regular E M R and a patient portal. I really like that. That's my current E M R and my staff will kill me if I ever change again.
And I've looked at some of the new upstarts and things like that, and I didn't at the time. There is a new upstart that actually just got bought out by a bigger company that we all know about. I really liked how their stuff looked, but it wasn't quite done. And so I couldn't switch because it didn't have all the things that I needed.
And I use my phone system. I like them because of their flexibility and because I can add things on like my E M R meshes with my I calendar, so I can see my schedule on my phone. Now I can't see everybody else's schedule on my phone, but I can see mine as a part of my regular calendar. It, for me, it's about streamlining it all down into the easiest format to use.
We use our phone system, you know, I pay separately for that because I can have one number for multiple clinics. And multiple users. My problem with the other systems that used like Twilio or RingCentral or whatever, it was only like it had to go to one person's number and for me it became very intrusive.
I was the only one that people could call or message. And so you never get any time off. So with our current system, somebody's on call and they're the ones responsible after hours, you know, that particular day or weekend or whatever. And that's nice cuz then I can sort of check out, plus that particular phone system is an EMR in and of itself, so it just keeps a running tab of what everything's doing and I don't feel like I have to move it back and forth into the chart, but it's trial and error, you know.
And I appreciate you mentioning that too because some people, you know, I've seen, you know, the person's internal debate literally on the pages of Facebook and you know, just hearing your story like you've changed DMR and you're still alive to, to tell the story, right? So it's like if you have to change EMRs, it's okay because you could do whatever the heck you want if it's your clinic.
I really do appreciate you sharing that. So when we think about your journey and how you started as a non-physician practitioner and then became a physician and have opened your own D P C clinic and now have three locations that are looking to add more patients and and people on staff, what is D P C?
Everything you thought it was going to be?
Yeah, I think for me, D P C is everything. It's not easy though. My goodness. I think it was Dr. Julie Gunther, you know, who talked about driving down the highway, hanging out of the van, trying to change a tire, right? I think that's her analogy. It does feel like that sometimes, but I really truly believe I'm.
Being the best doctor I can be in D P C, I don't think I would be happy being a doctor if I had stayed in the system. In fact, even though it was such a God thing for me to become a physician and I truly feel like I am serving the Lord in the way that I am intended to do that, I don't know that I would've kept doing it had I had to continue because it's really hard work, like really hard.
I don't think people appreciate that they, people are forgotten. Since you can just log in to Dr. Google and ask a question, they forget the blood, sweat, and tears that we go through and the responsibility that we have for other people. It's really taxing, but it's really rewarding. At the same time, I don't really have any complaints about D P C Foundry setting, maybe.
Like I work a lot and so I need to formulate, I need to get a plan in my head for how long am I gonna do this? What are my next steps? Am I gonna transition out? I don't feel like I'm ready to retire, certainly, but I see where continuing this amount of hard work is not always gonna be possible.
And that's so important for people to hear also, because I think about the parable of, you know, what has four legs in the morning, two at noon and three at in the evening. And it's the baby who's crawling, the person who's, you know, on two feet, and then the person with a cane and older age. And when we talk about the responsibility that we have, as we, you know, go into the career of medicine, we have to be able to take care of ourselves, to take care of other people. And there is a point where, you know, we have all chosen that, well, not all of us, but you and I amongst many other people, the thousands of people now who have chosen D P C as a business model, we have.
Already partly heard that calling to say, Hey, we gotta do what we wanna do to be able to continue serving our phys, our patients. But at the end of the day, you know, that is an okay thing to say, like, and I'm going to choose to now do less patient care or you know, more of more patient care, whatever you want.
So I, I think that's a very great thing to highlight that, you know, we're very big into like, how do you start A D P C, but then what ha what happens, you know, five years after, 10 years after, 15 years after. And thankfully, you know, we're seeing now a trend where there are people who, you know, might not be as gungho about starting a business from the ground up, but oh shucks, there's already a D P C open and I can I, that person's retiring from their D P C.
Oh my goodness. Like that would be a great fit for a lot of people. So I think there's definitely opportunities, but again, I am appreciate that you're highlighting, listening to that portion of you. Mm-hmm. Because that portion of you matters.
Yeah, it's definitely important I think, to pay attention to that because otherwise it's kind of, you get a little dis disillusioned, if you will. And I know, you know, you hear stories of people who've closed their D P C and you know, it's all hush on the side, like, oh, what happened? And sure some of that is actual business failure, but I think sometimes people get into it and they realize, wow, this isn't what I wanted to do. And that's okay. I mean, that's okay.
So I think it's important for us to know that and hear that. And I think too often we don't talk about it enough because we're all so busy trying to make this work. You know, everybody wants to hear the good, the only, the good stuff, but it, it is hard work and your heart has to be in the right place, you know?
And. Your heart has to be in the right place. And like, you know, just as a reminder for people, if they're in a place where they're struggling, you know, business-wise, patient volume-wise, whatever it is, there's a heck of a lot more people like we've mentioned out there to commiserate with, to ask about, to get help from so that you can, you know, continue to have conversations, whether you're gonna continue on in your practice joint or practice, close your practice, whatever it is.
So with that, Dr. Allen, thank you so much for joining us today.
Thank you, Marielle. This was fantastic. I'm really proud of the work that you've done getting d p c out there for all of us to hear. It's, you're doing a great job. Thank you.
Next week look forward to hearing from Dr. Cindy Dhi of Archway Family Medicine, DP C in Pasadena, Texas. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about D P C. Leave a five star review on Apple Podcast and on.
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*Transcript generated by AI so please forgive errors.