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Episode 104: Dr. Leslie Surbeck, Dr. Shary Vang and Dr. Anita MacDonald of Evergreen Primary Care

Direct Primary Care Doctors

The Co-Founders at Evergreen Primary Care
(L to R) Dr. Vang, Dr. Surbeck & Dr. MacDonald

Dr. Leslie Surbeck graduated from Undergraduate at Bryn Mawr College in 1997 and then went to Medical School at University of Minnesota, Minneapolis, MN, where she graduated in 2004.She completed her Residency at Hennepin County Medical Center, Minneapolis, MN in 2007 then served as Chief Resident from 2007-2008. After resiedncy, she served as a Staff Hospitalist at Hennepin County Medical Center and Hudson Hospital from 2008-2011and then became a Primary Care Physician at HealthPartners from 2011-2020.

She loves learning about each unique person and working together with her patients to find solutions that fit. She tries to approach every clinical situation with humility and an open mind and believes the practice of medicine should be evidence-based but never one-size-fits-all.

Her Interests outside of medicine: spending time with her partner and our two daughters, gardening, and long walks.

Dr. Shary Vang graduated from University of Minnesota in 2003 then attended Medical School at University of Minnesota, Minneapolis where she graduated in 2007. She completed residency at Abbott Northwestern Hospital in Minneapolis, MN beween 2007-2010 and served as Chief Resident from 2010-2011. She then went on to serve as Physician & Director for HealthPartners Center for International Health 2011-2021.

She is the proud daughter of Hmong refugees and her philosophy as a physician is simple: provide a space for patients to be heard, treat everyone like family, and provide the best care she knows how. Her medical interests include: Diabetes, Hypertension, Stroke, Thoracic Outlet Syndrome, Piriformis Syndrome, ADHD, complex medical care, Refugee/Immigrant Health

Outside of medicine she enjoys spending time with her husband, 3 children and their large extended family. She loves listening to podcasts including favorite are Terrible, Thanks for Asking, Unlocking Us with Brene Brown, Criminal, Heavyweight, and Where Should We Begin with Esther Perel. She is an avid pickleball player and supporter of her husband’s pickleball company, PikNinja Sports.

Dr. Anita MacDonald attended undergrad at Amherst College and graduated from Medical School at Case Western Reserve University in OH in 1997.

She completed her Residency at Forbes Family Practice in PA in 2000.

Prior to DPC, she was a Primary Care Physician at HealthPartners Health Center for Women from 2004-2020 and then served as their Clinic Medical Director between 2010-2020.

She loves the ability to have relationships with her patients in DPC and feels listening, partnering with, creating a plan together, coaching, empowering and advocating on her patient’s behalf are all essential to her practice. Outside of medicine, she enjoys time with her family, appreciating the beauty of the natural world, true crime podcasts, meditation, educating herself about and doing what she can to promote racial, economic and climate justice.

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 Welcome to the podcast guys. Thank you. Thank you. Thanks for having us. You guys are the first physicians from Minnesota to be sharing your story on the podcast. So I'm really looking forward to the audience hearing more about your story and more about how DPC is going in St.

Paul and in Minnesota. So I wanted to start though with, with the idea that you three are three physicians who founded your direct primary care together, and that's not a typical thing that we see. We see a lot of micro practices. We see people who are having people join them later on. But how did you guys happen to come together to open Evergreen Primary care?

Well, a little bit of serendipity. We all did practice at. Partners and Anita and I actually worked at the same clinic for several years. Anita was medical director there, and she actually hired me when I started there. And so Anita and I knew each other, and through Covid we had quite a lot of disruption to our practice.

Our practice, our group was moved several times, and then the organization decided to kind of dissolve our group, our clinic, we are, we were at the Health Center for Women, but we were a group of seven women physicians all doing primary care. And so when that happened, I think for me at least, it was almost like the last straw.

There were a lot of things about working in a big organization that were frustrating and I, I had always thought about leaving and starting something different, but I, it's a little bit scary to do that. And so when this happened, it was kind of like, Well, if I'm ever gonna do this, if I'm ever gonna go independent, like now is the time.

And so that was sort of the. Impetus for me. And then it turned out that Anita, also, the clinic had closed and, and she had decided to take, and I'll let you speak Anita too, but she had decided to take a little time to like think about what she wanted to do. And so at, at some point decided like, Okay.

We're in this together, we're gonna do it. And then we actually hooked up with Sherry through the DPC Facebook group, and I put on there like, Hey, is anybody out here in Minnesota? ? And then Sherry, you said, Hey, yeah, I'm, I'm out here and I'm interested in dpc. But you weren't, you hadn't started anything yet.

And so then we kind of all started meeting and because we had all worked for health partners, we had a lot in common, a lot of grievances in common. And we started meeting and it was kind of just like, Hey, yes, this is what we wanna try. And now is the time. Yeah. I would say from the story, I always say like, it was very traumatic how my clinic was closed.

Dedicated 16 plus years to the organization. You know, I was moved to another clinic, was never, not with any of my nurses, not with any of the staff, not with my, my work home, All the reasons why I was staying with the organization. And so I left, I said I was giving myself a sabbatical, left on good terms and just took some time off.

And then I, I worked in the hospital as a hospitalist for a few months during the first surge. And then, and then I was looking around at trying to get another job and looking at different organizations and it was just, The same issues everywhere. It wasn't just our organization really, it was just constantly, you have to see so many patients because primary care doesn't make enough money and you have to build code more.

And we all, everyone knows this is a problem and we're gonna try to fix it, but having the experience of 16 years in the organization where they're constantly saying, We're gonna fix things because we know primary care is not sustainable and it not happening, so, So that's when I had been learning. I actually did the DPC sum of the AFP one using up my CME money before I left the organization.

And so I was really interested in it. I'd heard about it before, but the idea of starting out on my own was daunting. And then, Leslie approached me and said she actually, I call her saying that I'm gonna do this and I'd love for you to join me, but I'm gonna do it . And so, All right. Well, and then we had our first meeting.

I think our first meeting was the three of us at Leslie's place. I just have this memory of us meeting Sherry. I'd known Sherry a little bit, but I just knew from that first meeting that this was gonna work, that we shared the same values, same kind of approach to patient care. I could tell we would be able to work together and it was just so exciting and I'm.

In some way. I mean, a lot of ways it helped me because I don't know if I would've done this on my own. It helped so much to do as a team and go into different reasons why, but that, that's what brought me here, to Evergreen. So beautiful. And, and Leslie, you called it, it's so serendipitous that this happened.

And Anita, I just really love that, that you highlight that you might not have done it had it not been for the three of you going in this together. And it's really important for people to hear that. Sherry, can you share your take on how did things go from meeting on Facebook and then taking that the good side of Facebook to actually opening a, a. Yeah. You know, I was, when I left, when I finished a residency in my chief year, I, I kind of found my dream job right out of the gate. I was working in this primary care setting where we were supported by a large healthcare system serving a population of patients that, like, really it was my goal when I wanted to be a doctor was to really be able to take care of immigrants and refugees.

And so I thought I was gonna stay in my job forever, but, you know, as, as more years come by you, you realize, okay, there are certain things you don't like about it. But I had sort of made my peace with it, I think more so because I also had three small children. And so I was like, Well, you know, there are some things I didn't like about it, but we'll make it work.

And then about two years before I'd left, I think I started to really. Feel like there was a lot that I was having to give up personally and professionally to that I really didn't feel like I was enjoying about primary care anymore. And so once the pandemic hit, and I think I had all my, my three kids at home and I was, it was between my husband and I with no other childcare, it really made me open my eyes about what I was doing in my life.

And I had so many people in my life prior to that were like, Oh, when you can open your own clinic? And I was like, I would never in a million years do that. I, at my current job, I was working Tuesday, Wednesday, Thursday, I had four days off outside of that every week. And I was like, this is honestly the perfect setup to be raising my three children.

So I really didn't think I was gonna do it. And then once the pandemic hit and I really had to stop and look at what I was doing and how life was for me and where I was professionally, I joke about it. Like going through my midlife crisis, I realized that I couldn't. And it, it was funny because at that time during the pandemic, our employer came up with this new hour shift where they needed us to do more evening and weekend hours.

And I said, Well, for people like me who are caregivers, that's not so easy for us to do. So what can you guys do to help us? And there really wasn't an answer on there end. It was just know, what can you do to continue to stay your job? And so for me, I think that was the push for me to decide do I wanna stay here or is it time for me to leave?

And so I think it was July or August before I left, I actually started to explore the idea, like, could I go on my own? Cuz I had heard about this whole DPC model and I knew I wasn't interested in opening up a, a traditional model clinic. And so, I started to explore that. I even went to look at space and I thought, Okay, I do the numbers.

This is what I need to do to make ends meet. And I really thought about it and I thought, Okay, we could do this. But then when I really sat down and thought about all the other aspects of my life that I needed to manage my children, my marriage, I was like, There's no way, even in the DPC model, could I go on it alone.

So kind of like what Anita said at that point, I said, You know what? I just have to hunker back down and do my job and try to make it work with my employer. But in the end, it didn't work out still. And so when I left in March of 2021, I said to myself, I am gonna enjoy my unemployment. I'm going to set it out for a month, and then I'm gonna decide like, do I really wanna stay in medicine?

Because at that point, that whole previous year, the pandemic with what was going on with my employer and negotiations, it. Made me really reconsider my life as a primary care physician. I mean, I, I feel like. Prior to that, like I was very grateful in my life that I got into medical school when I did and I got into residency where I wanted, and then I got the dream, the job of my dreams.

And so like I never had to really stop and really think, Is this really, really what I want to do with my life? Is this what I wanna spend my life day in and day out doing? And so this was the very first time in my life where I really had to stop and really decide. Life really is too short. Man. My dad died when he was 63, you know?

And so for me, I was like, do I really see myself being a physician? If this is what physicians, if this is what our life is like. But for, so for that one month, I did decide I was not ready yet to leave medicine. But I knew that I couldn't go back into a large healthcare system similar to Anita. There were other organizations who were like, Oh, just come work for us.

And I would've worked with a similar population. But I think the way in which I departed it just. Left me like I had a distrust in the large healthcare system again, that they would value me as a unique physician with a unique skill set and would be able to support me, like I support them in everything else that they had asked me to do up until that point.

And so I really couldn't go back into the large, large healthcare system. So what I saw Leslie's post on Facebook, I was like, I think, I think Leslie with the, The Post was something about asking for a lawyer that knows about dpc. And I reached out and I said, I don't know anything about that, but there is this space that I did look at.

And then I think two weeks later you're like, Are you interested in opening dpc? And I was like, Actually, And my one month is up, so yes, let's talk . So I think that's kind of how we all started it. But yeah, and I'm love it. Yeah. I'm just grateful I, I. Going to do it regardless. But I joke that if they hadn't come with me, if I hadn't met them, if they, I'd probably still wouldn't be open yet.

Like it is just so, I'm so fortunate to have you guys helping and carrying the weight part of the weight because it is a lot of work. And, and also just to have like people to practice with who Yeah, share, share my values and all of that. It just makes it so much more enjoyable and less scary. So. And we were able to, we had that meeting in March or April, was that our first meeting?

April? Mm-hmm. . And then we opened in October. I mean, so because the three of us were working together and, And Leslie, you were still working somewhat and then Sherry and I were most, were pretty much not working, so we had the time and we could just, just focus and it was amazing how quickly we were able to make all the decision making, which I think would've been, it was one of the main reasons I would never have been able to do it by myself.

Cuz. Have a hard time making decisions, like just even coming up with a name, uh, , I wouldn't, I, I would, I wouldn't have come up with a name by this point in time, but having, we each have our own skill sets and it's great just to be able to run things by each other and, and, and now we have, like, we had our first, um, retreat meeting where it kind of spent the whole day looking at where we are and you're able to like kind of divide up our tasks a little bit into categories.

So I'm more the finance, bookkeeping, insurance person. Cause those are my, that my attention to detail and just focus and things that need to get done, get them done. Whereas Sherry is our marketing media social media person. She's so great at networking and just cons, lots of ideas and just so much energy and follow through and so good with people in that way.

And. And Leslie is, you're our hr right? . But she able to build our face, our, our, uh, website. But she's got great, like just the design. I, I'm not very creative that way, so I like, I wanna be able to build a website. I mean, it's just, it, it really, I think we kind of balanced each other out so well, and I'm, I'm, yeah.

I'm just so grateful. I love this. And so when you mention, and I, I love, I really appreciate how you just laid it out there. Like, I'm the financial person. Leslie is the, the HR person. I'm sure she's, she's gonna love that for the rest of her life. And Sherry is, is the, the social person. Can you though, start us back at when you had that meeting in April and you were like, We're totally gonna do this together. What were those initial goals that you had set out and where are you guys on your trajectory?

Gosh, you guys jump in too, but I, I mean, I think that when we first met in April, I just wanted to figure out if it was possible, if it was possible to practice without support from an organization. Like, could, could I just me, with my training, take care of patients and provide comprehensive primary care?

And it turns out that we can, and we can do it for. Really pretty darn cheap. And that, so, so in that sense, like I think we've accomplished what we set out to initially, and now I, I feel like the, the focus for me is more on, okay, how do I make this sustainable and how do I get to a point where I'm making a comparable salary to what I was?

Because I mean, I think it's, I think DPC is a really important option for patients to have, but it's also, in some ways even more important just for physicians to have it as an option. Because in the healthcare field, I feel like there's been so much consolidation and it's not very diverse. Right. There's, there's really.

Model or couple models. And, and I don't think that lends itself to a very healthy industry. And I think that the, the physicians have really lost a lot of power, especially in primary care. And so I want this to be able to pay me not only just for me, but so that other people can do it and survive and have a, have a good quality of life and a good income.

And so I would say, I also would say one of my other goals was not to lose a lot of money , cuz I was, that was what I was really scared of, was like investing a bunch of money and not, and then losing it. And we have far exceeded that. Like we are making money. So now it's just about growing my practice to a size that that is sustainable financially.

So awesome to hear. And how about you, Anita and Sherry, in terms of how you guys look back on that April meeting and then look to today where you've reevaluated, where you guys are on the trajectory, What are your, what, what do you recall from that meeting in April? And what do you feel about your future today?

We were reflecting on this last week and I, I think I was the only one of the three who was like, I wasn't, I, I didn't have any doubt that financially we would do well. I think I just know like for, for, I mean, between the three of us, we've had over 40 years of experience. So for me, professionally, I knew that that was not gonna be a problem.

And I, but like I said, even when I was looking at my own financial picture being a primary brandner, I had no. Fear going into this because, and when we talked a little bit about your exit strategy, right? Like, and I think for me, I, because I already knew I was unhappy in my current situation, I was already starting to like do bits and pieces of like doing more procedures, figuring out what else I could do besides just straight up primary care to, in the, in, in the event that I did ever not have a job in my, with my current system, that I would be able to be self-sufficient and be able to make my own and to create my own cash flow on this side.

And so that's what I had going into this. And so for me, uh, I didn't worry about it, but like, like it, Leslie said, I think for me it's after this first year, it's been trying to. What it's like to be a business owner because my husband is also a business owner and we've got three young children. So for me it was more of just how is this gonna work in my life besides work?

How do I balance life at home? And because I really can't shut off my brain from the business, there are patients that might text me or I have this to pick up on, or I have this part of the business I need to work on cause my partners are relying on me to follow through. So for me, it's just been a figuring out what my schedule looks like, what how to build tho and create those boundaries with my patients.

And then how to be a more efficient business owner. So I'm looking forward to how to grow the business now that we kind of have a foundation. I, I love the, the, the chances that I get to speak with physicians like yourselves who have, who have decided on dpc. You guys are, are very much in that sophomore phase, and you have so much wisdom now and so much confidence differently than you did when it was like, Well, forget this.

We can't go back to that. What are we gonna do? And So, Anita, when it comes to your, your take on things, can you also highlight the financials because you are the financial person of the, of the clinic.

How did you guys come together to, like Sherry was saying she's a primary breadwinner and and Leslie wanted have the clinic continually be profitable. How did you guys look at things in terms of strategizing, how you would take patients on and how you would benchmark your financial growth?

Well, I don't know if it was so systematic. I mean, one of the, the, like I had, I mean your podcast has been incredible. I mean, it's one of the Totally, I think I was still like, I don't know if this is, It sounds to be good to be Drew. Can this really be done? You go to the DT Summit and you see, well neither there are people doing it, but they're just in rural areas and is that gonna work here?

And where there's insurance, these big health systems just dominates this area. So it is really worried about how, how that would work. But, so like I remember you did, I think it's Lauren Heady for the Burden Free with the Burden Free dog. I mean, I listened to that podcast and then I looked at her blog and she did a fireside chat at one point.

And just to see like, you can really, my take that we can really doesn't cost that much. You can really, I mean, the prices of the EHRs are very doable. Like before I, we used to Epic and cow in the world, like small, small practices can't afford epic. How can we, are we just gonna do on paper? Like, but no, they're actually very affordable.

Do we, We don't have to have staff at least, but not at the beginning. And obviously you don't need to have coders and billers. And so the biggest cost is really the, the rent that's really been our biggest cosmo practice isn't too bad here. And then we were just, and it was part of the, the fun of building the practice like most of.

Our equipment and furniture we're on Facebook marketplace, eBay, driving all over the place to pick stuff. Got a $250 autoclave and that that we got donations. I mean, it was really fun putting it all together. So, but my focus has always been just keep that bottom line really low because I don't wanna go into debt.

And then the lower, we keep our regular operating budget, but we can easily meet our expenses with smaller, smaller number of patient members. I think my biggest challenge has been at the beginning, and it's still an ongoing challenge for me, is the price point. How to come up with the price point. And it's always been like, well, there's a question.

I have insurance. Why would I pay? $80 every month in addition to my insurance when I don't have to. And I think all the three of us are similar in that we really didn't want to just be doctors for the wealthy, for people with a lot of expendable income. And so how do you, how do you make that work?

And I love the podcast, the, the episode with Garrison Bliss. And he, and he just opened my eyes about how flexible you can be with the, with the pricing. Like we have our set pricing, but you know, I have patients where I don't charge that much for them. And, and we have a patient assistance fund and we really want to be able to, I, I think I really.

Make it affordable, but what's affordable is different for different people. And that's the part that I always struggle with. So in terms of like, how do we, either you have to have a larger panel to be able to make the, and charge the price that we're doing, or do we need to raise our prices so that we can, we can have a smaller panel.

That's the, I think that's the challenge. And honestly, right now we're, I'm feeling pretty good about where I am, but I'm not, I have about 125 patients on my panel and it's pretty comfortable pace. But I'm busy every day and, and I'm not frankly making what I, what's making in my other job. So it's like, how do we, how do.

Figure out how to either, Yeah. Do we need to increase prices? Do we need to just grow more? Do we need to, this the point now where we need to get some additional staff. We've talked about getting a virtual assistant because to offload some of the work that we're doing now. I mean, that's a, that's, these are all the issues we're dealing, we're, we're trying to figure out.

But that's also the thing about this whole journey. It's been like, Okay, well let's try something. Let's change it here. Why don't, it's, it's, that's what makes it so fun. And, and I guess I would say the other thing that, you know, in terms of what I've learned and kind of reflecting back on not so much the financials, in terms of just practicing and, and being able to practice medicine the way I feel people deserve to be able to get the kind of healthcare where I can have this relationship with my patients and I can not be rushed and I can spend the time with them and I can look things up and I can follow up with them.

And then also just hearing from my patients, like I was worried about, well people pay extra for this. And I have so many patients who say are so feeling so lost in adrift in this current system. They can't get in to see their doctor there or it's weeks out, or they have chronic conditions, but they've got different specialists managing different things and they don't know who to call when something comes up.

They just feel, especially in number of my more complex patients with chronic disease, they are older. They just, they really feel. Abandoned in a lot of way by the system and scared. And so they tell me how, how helpful it is to just know that they know who to call to have me there. I'm on their side, I'm looking out for them, and they can get in when they need to.

It's, I mean, in that way it helps answer that question for me about why would you pay extra? And, and it's just what was surprising to me. That's in terms of when we started to now, that's been one of the most surprising things is about how happy, how much my patients are actually valuing and willing to pay for, for my care outside of insurance.

It's, it's truly incredible. And as your practice has grown, you, you can always look back on the successes that you have already experienced, and you're not even within your first five years. It's, it's incredible. And especially Anita, as you shared 16 years working for a system that promised to change and to change and to change and never did.

And Sherry, how you, how you spoke about how the organization. Was, you were working so hard for them, but then it was up to you to maintain your job. I mean, it's, it's just so different when you are sharing now your story at Evergreen because you, you are, are saying it like it is you, you don't know. And then you try something and then if it works, it works.

If it doesn't, you try something else, but you have that autonomy and you guys are determining that autonomy together. Now I wanna ask here in terms of the people who have found your services to be incredibly valuable and necessary, who are the people who have joined your practice?

Cuz Sherry, I know you mentioned like your dream, your dream job after residency was where you could serve people who weren't super, super wealthy immigrants and people who truly need care and culturally sensitive care also. So who has joined your guys' panels? I have a pretty, I think, a very unique mix of patients.

I have several Hmong patients as well, and these are patients who have typical patients that would be served best in the DPC model. They have jobs, they're employed, but they have high deductible insurance, so I have a handful of those. I, I also, as a side, I don't know if you consider a side gig, but as a side offering to dpc, I also do these immigration exams, and so I've actually gotten a couple of patients from that because I do have some, again, individuals who are here legally but don't have any insurance coverage.

And so this is a really affordable way for them to get ongoing care. And then I would say the far majority are still working individuals with high deductible, but I do have several wellins insured individuals who just have significant enough health needs that they require that ongoing relationship with a physician.

But I, it is, I have a pretty diverse panel of patients, so I'm pretty happy with that. I think that's been pretty interesting to me too, how diverse our patients have been. So we, I have some of my patients that have followed me from various places that have good insurance and are willing to pay.

We all have some Medicare patients who have Medicare and supplement, but again, just because they value having a home where they can communicate easily and directly with the physician, they're willing to pay that. But then, yeah, we have people on health shares, we have people with high deductible where they're doing it.

To save money. And then we have, or I have some people who are self-employed or don't have insurance, which I don't recommend, but this is what they can afford. And so it's better than having nothing. Right. And so it's really fascinating to me because it's like this huge swath of people, people coming from really fancy neighborhoods and then people coming from not so fancy neighborhoods.

So it's, I, I really like that, and it speaks to how DPC is really filling a, a need out there. So, absolutely. Anita, how about you and your panel? I think it's pretty similar. I do have, since I've been in practice in the Twin Cities for a fairly long period of time, I do have a significant proportion of my patients are found me, which is, again, it's like, cuz I left and then I was gone and I left and I didn't, I didn't know what I was doing and, and I felt like I was abandoning my patients, but I felt I didn't have any other choice at the time and how, how, just emotionally hard that was.

And then now I just will like, see someone pop on, on my schedule for a meeting, greet someone, one of my former patients, the familiar name. And it's just, it's the best feeling, I mean, to reconnect. And so, so I do have quite a few of those. And then it's similarly, like I have a few uninsured patients and then a few patients, probably more, who have these high deductible health plans where it's just, this is a, this is a financially good decision to, but they don't need to have a lot of expendable income.

They're actually saving money with a dpc. And then we also have an employer, which is bad. We're trying, Well, that's our goal, is to try to get connected with more employers who can pay. I mean, I think that's the sweet spot really for, for this to become more affordable for people is to have employers pay for the membership, for their, for their patients.

And so we have, we do have some of those patients as well. And when you talk about the employer group who has joined your practice, what is the demographics of this particular employer Who's joined your group?

Well this is, it's pretty interesting cuz they found us, They, I think they went on the DPC mapper even. So they are based in Wisconsin and have been working with reform medicine in Wisconsin, a large DPC group for a time. So they are very familiar with it. And they opened up a satellite office there, uh, an engineering company, and they opened up a satellite office here in the Twin Cities.

And so they just were looking for DPC and they found us, I think they contacted us before we were even open . I know. It was incredible. And so we didn't have to sell them, we had to sell their employees because it's a choice for the employees. But they, what are they, medium size? I mean, I think we have about 15, 20 patients in our practice from them.

Yeah. . Awesome. And when you talk about selling the, the practice to, not the employer, but the, the patients themselves. I wanna hit on Leslie, how you're designing the website, Sherry, how you're doing the marketing. How did you guys come together to collectively come up with the, the key highlights about your practice that you wanted to share and, and make sure people knew about going into working with employers, or reaching out to just members of the community.

In my mind, First you ha you decide what you wanna offer and what you have to offer, and then you let the marketing develop from that. Right? And I always, I would always get kind of grouchy, like before when I worked at, at this, the big employer driving down the street and seeing like a big, billboard that had some like marketing phrase about our employer, right? Like, I don't know, whatever phrase they had paid a gazillion dollars to some firm to like come up with, right? And, and it was always kind of like, what that doesn't, that has nothing to do with what we're doing in the clinic and or talking about their latest campaign and blah, blah, blah.

And it always felt so disconnected from what was actually happening in the clinic. And so, I don't know. I guess for me it just always seemed like, okay, well, you know, we just describe what we want to bring to people and, and, and the people who feel like that is something they're looking for, will, will, will find us.

But that's probably very simplistic. But I mean, I don't know that we, we sat down and said, Okay, like, here are the people we're gonna go after, anything like that. We just said, Okay, well who are we? And let's like tell our story. And then, and that's why, I mean, I think the, the name Evergreen too resonated with us because it's organic and growing up from the roots and natural.

And it's not, it's not something that we're trying to, it's not fancy, it's not flashy, but it's strong and, and secure and, organic. So that's just kind of what I think of, of how we present ourselves is like we're doing basic, comprehensive, high quality primary care and we're in the trenches doing the work.

So like we don't need a lot of snazzy stuff to, to sell it. I was just gonna say, and I think that translates to, I think what brought a lot of media attention eventually to us is because for us, I mean covid, the pandemic and vaccine and the, the whole equity piece of vaccines was a really big part here in the Twin Cities as well as throughout the nation.

And so for us, when we had opened up our clinic there, we realized that like for me in the Hmong community, that there was still a whole bunch of elderly Hmong folks who still hadn't gotten their booster yet, or some who hadn't even gotten their primary series. And so that was one of my goals. And like I can now build a clinic that I want then yeah, if I can get free vaccines and I can vaccinate the community at large that I.

Like I have my business housing. Why not? And so the three of us agreed to give out vaccines free to our community, to our neighborhood. And so we went into the Facebook groups of the community that we live in for me, into the Hmong community on my personal Facebook. And we really held a lot of community drives cuz we were also building our practice at ti at that time.

So we didn't have many patients. And so for us it was like, why we can do so many things at once. This is like a easy way for us to market ourselves, to bring people in our doors, but to also offer a service that is so much needed in so many communities, Even in the community, which we have our clinic in, in the midway area in St.

Paul, which is one of, probably one of the poorest communities, uh, in the St. Paul area, the one of poorer neighborhoods. And. For us, it was really important that we also take care of the people around us. And so I, that's how we got some people who work at the in post to come to our event. And obviously we, we always use it as an opportunity to tell people about this model because for us, it's not even coming here, but just to know that there's an, we're not the only ones in town.

And, and so that piqued their interest and they went back to their newsroom and they started talking about it, and then they reached out to us and we got a story. And I think that's how Minnesota Public Radio heard about us too. And so that's where we got some natural media coverage, which really, I think brought us out into the larger community as well.

So we were very fortunate. And I wanna give you guys props in terms of when you visit the website for Evergreen Primary Care. There's actually a media page. And so you guys have highlighted where you've been featured in the media. And I think that, especially for the movement, if, if people are listening and if they have not thought about that, or they have not yet interviewed or done, or been featured in an article, it's something, something to think about.

Putting where you've spoken about your clinic, your practice, your way of practicing medicine, your DPC on your website. You, you never know who is going to find your website and you never know what time of day they're gonna be on there. But if it's on your website, it is for people to, to find it. So just like how you guys were thinking that the employer found you guys on the mapper, if somebody approaches you from St.

Paul, they're like, Oh. Of course this is exactly what I want to continue to feature in in another media. So I think that that is amazing that you guys have that on your website. Just wanna highlight that. Now when we go back to Sherry, you mentioning that you guys have a clinic that's not necessarily in the richest part of St.

Paul. Can you share about how DPC is in Minnesota when you talk about there's other people in the neighborhood, so to speak, and when you were looking for a space and you had potentially found a space, which is now your clinic, what was appealing to it that was that, that made it a potential space for you guys?

We all knew we wanted to stay in St. Paul, Leslie and Anita. Their clinic, uh, was also in St. Paul. My clinic was in St. Paul. And in fact, I think we're all about what, less than a three mile radius from our previous location sites. And thankfully we are. We did not have a non-compete, and so we were able to, we kind of had our choice where we wanted to stay, but for us, we knew we wanted to stay in St.

Paul because that's where diversity is a really big part of our desire to care for people. People of diverse socioeconomic status, people of color, of different sexual orientations. So for us, it was really the only natural choice for us to be in St. Paul when our location. Perfect, because I, I think for me, one of the big draws is the covered parking.

My, my one of our older buildings. And so I was stuck in a cubicle in a basement and so I, I always looked for a better space and so I have a good size broom with windows. And so for me personally as a professional, this really checked off all the boxes of what I needed.

And I think for us, the three of us, it was the perfect amount of safe space to start out. It's a four room exam room office with a tiny little lab space and a, a little waiting room. So I think it's perfect for our needs at the moment. And we really like it cuz we have our own office and our own, So that is only, not only our office, but also our exam room in one room.

And so we kind of have our own little space and so it's, it's perfect for us. Awesome. That's a good vibe. And that we're in Minnesota so that. Covered. Covered parking. Parking under the skyway that goes between the parking garage to the second floor where we're located. So you get to stay inside the whole time.

But we, I mean we really looked, I mean, when I think too price is a big, was a big thing to start out cuz that is the biggest expense. And we actually looked at a lot of alternative spaces too. We, we looked at churches, which I. Could have been a really cool thing, but all of them needed a lot of build out and so, And actually there was, there was even one little house we looked at , it was like, but it was just too, it would've just been too much and this was like ready to go.

Really didn't need a lot, was at a good price point and had covered parking. So I love and some located, Yeah. Yeah. Awesome. Having grown up in Sacramento and then going to Omaha, . Like I saw Brian Yang, he's a psychiatrist now. He had his remote start for his car from the window and I was like, Oh my gosh.

The things that they make these days for keeping warm. So I absolutely understand where you guys are coming from. So now, when you guys then found your space and you, you found that had clinic space enough for each of you to have your own clinic, how do you guys operate the day to day? Do you guys all work every day?

Do you set your own hours depending on your patient needs? Or do you have set hours per. Kind of set our own. I mean, we have, the clinic is technically nine to five, Monday through Friday, but we use elation and we can just set our own hours when we're gonna be in the office. So it's, it's very, I'm here like all, I'm here pretty much nine to five.

I think sometimes I come in a little bit later, but I always have work to do and I can get it done here better than I can at home. And I just love the space too. So I just really like it here. And uh, but yeah, I think we all, I mean it's nice. I think we've got a good balance of the flexibility of the practice, you know, group practice in a way.

So there's some things like our pricing. Standardize or some decisions we have to all agree on, but we do have the flexibility to set how many holds I wanna put in my schedule, or which days I wanna work, or which days I'm gonna work from home. Or there's, I think there is a, a, a good amount of flexibility, which is important.

And with, with the technologies these days, with these speech EHRs and, and we use Elation, spruce, and Hint, it's, it's really great. I mean, with the phone trees we do through Spruce, that also helps so we can easily cover for each other also. and Anita, earlier you had mentioned that you guys are at the point where you're considering having a VA join your practice in terms.

The things that you guys have evaluated to say like, Yeah, we could totally hire a VA to do X, y, Z. What are those tasks that you guys have identified that a VA could help you out with? Well, I should say I'm the one who's most resistant to it because I'm always like, bottom line, we can can't pay someone else cause then we won't be able to that amount.

And, and I'm also not very good at delegating and I just like to do everything myself cuz I know it's done right and if someone so, and it's working for me so far, but I do. I think Sherry and Leslie are more reasonable about this. And there are things, scanning forms and I mean doing referrals, you, you all know actually probably better cuz I just hang on to all these things so much.

And I actually do like, like, I like all the variety of tasks. That's sort of why I went into family medicine too. I just love variety, so I don't mind, like I do laundry, I sweep the floors. I, I just love it. I do , I learned how to do the spreadsheet site. I like doing the blood draws and the, all of that. But yeah, cause I don't necessarily like scanning the forms this much, particularly scanner, but I probably, Leslie and Jar can speak more about the different tasks.

Yeah. I, I think it's, yeah, a lot of the paperwork, the forms, the communicating with patients about non-medical things. Billing. I mean, we don't Bill a lot, but for like labs and other procedures or or whatnot, it would be nice to have someone do all that organizing and do that. I get, I get behind on that some, but I agree with Anita.

It's, it, it's fun to do different tasks. Like I love the blood drawing and doing the centrifuge and all of that, and like figuring out the ethernet in the, in the office. So I, I do, I get that and I, I like it, but I, I would probably, I would like some help with the forms. , definitely. how about you, Sherry?

How. . I think that's true for me too. Like, I mean, for example, like in our practice we have a fax inbox. We, we use elation for our emr and so we have a fax inbox and my day is to deal with the faxes on Monday, Anita has Wednesday and Leslie has Friday to make sure that someone's touching and sending out the faxes to the appropriate patient charts.

And so it's things like that, right? I mean, yeah, realistically it probably only takes less than 10 minutes of my day, but it's just the interruptions throughout the day that make me inefficient as a physician. And so my goal is to try to use my brain where like where I can grow the business. And for me, now that I know how.

Put faxes in each patient's inbox, like in the inbox for my colleagues. I want to be able to offload that to someone else to do so that I can use my brain and my energy where we can grow the practice and not just to sustain the practice. And so that's where we're hoping to move this next year, is to offload a lot of those tasks that aren't helping us grow the business anymore and buying someone to help us with that.

I love it. All, all seasoned DPC talk there, right there, guys. That was amazing. Now when, when we talk about EMRs and tech that you guys have chosen, how did you guys decide on your tech? You mentioned that you use elation, hint, and spruce. What, how did you guys go from Okay, we've, we've been used to the, the big box, uh, EMRs to this is the one that we want collectively.

Well, it is hard to make a decision. I mean, there, there's so many, which is awesome. But I remember, I think it might have been on your podcast, someone making the comment that sometimes it's not the most important thing is not making the best decision, but just making a decision . And so I just all, we, I had that in my mind because it's like, you just, you can't, you could research EHRs for months.

And so Anita, you were the one who kind of spearheaded that. And, and that was really helpful cuz she would kind of looked at a, a number of 'em and like looked at the costs and because there are a lot of hidden costs too. So one may look like it's cheaper initially, but when you put in the credit card fees and this and that and that.

And so she sort of did that comparison. But then at some point we just had to make a, a decision, I think. Well, we had the demos, it seemed like Elian. Kind of was looked like reasonable to work with and then they had a great introductory offer. I mean, I think ultimately, especially since, you know, we were starting out with no patients, I think that was a big part of it.

And we also, we started out using their, the, their billing membership management, cuz they had, they had started that and it worked pretty well. It was just when we did get an employer, Hint was so much better. And, and Hint as a financial person, much easier to expect the information I need to do our bookkeeping every month.

So I like, I like Hint for that reason. But yeah, I think it was, and and frankly it's all these resources. It's your podcast, It's the QPC docs. Facebook page, dpc, women's Facebook page, the Atlas's site, the bagel checklist, all these , the DPC frontier, all of these. And I think the Facebook group's probably the most, Cause it's so nice, you can just search on whatever EHR you're looking at.

And at the time there was even somebody who had put, made up a spreadsheet of Serbo, elation, Alice, I think acute and and, but uh, yeah, I think it, we had good introductory offerings from, from all three of those with elation. We did learn just for tips for other people. If you do a contract for a year, you can keep the 2 75 per month pricing for it.

But you have to agree to a year contract. And we pay ours quarterly, although we're actually looking at possibly switch. Now to, we're looking at Arrow gpc, so it's, But you guys are, you guys are right out. Yeah. You're making the decisions as it comes. So that's, that's important. And in terms of something else that Anita, you had brought up was the idea that you guys have a patient assistance fund.

And so when in your, in your journey did you d guys decide that you were going to create that fund? And how, how have you funded it?

I honestly can't remember how we came up with the idea. I know that we had a little bit of money. Yeah. I think for me, again, I think it goes back to kind of like what I, what really makes, uh, my, my purpose in being a physician, right? It is to really try to encourage my patients to be healthy and have a healthy lifestyle.

And so, and I, and I really believe in this model model, and I really believe in its ability to care for people. And so I never. For, for those patients who want to be a part of my practice, I, our goal was to encourage them to, to never have cost be a barrier if they wanted to continue with our practice for some reason.

And we really wanted to work with our patients, but also to encourage them to seek preventative to, to have ongoing preventative healthcare. So our goal for the Patient Assistance Fund was to give some like scholarship to our patients who needed a little bit of assistance with payment of their monthly membership, just so that we can support each other's physicians too, because, I mean, we love giving free care, but we also at the end of the day have bills to pay.

And so this is a way to help each other. We haven't really used our patient assistance fund for our memberships. Most of our patient assistance fund has been used to help pay for pap smears. We have some skin biopsies for some patients who are uninsured that tend to be a little bit more expensive in the a hundred, $200 range.

So we've used it for things like that. But as far as sources of funding, I. I had a patient who just absolutely loved the care was giving him, so he whipped out a hundred dollars bill for a tip, and he's like, Put this in your fund. And so like, Okay, great. Thanks for that. It's, it's come from various sources.

I mean, I also, I also donated to it. I had this little tv, uh, stint that I did, and I got some money from that. So instead of using it for myself, I said, Oh, well put this money into the fund. When we had our open house, we also had a little raffle drawing for some items. My husband has a pickle ball business, and so we were, we were donating some of that stuff and people donated money, so it's just little bits here and there.

And then I also applied for a grant, and we haven't actually received this money yet, but it'll be coming up in December. There's a community in Min, a co-op in Minneapolis that is, they select businesses to donate. Tips for, And so we were selected to be the December recipient. So roughly, we'll they said on average people get about a thousand dollars.

So that'll be going towards our patient assistance fund too. So we're just, Just different ways people can support us for our work and so that we can continue to take care of patients and continue to keep people healthy. And then, oh, and then Anita's mother-in-law also. You can talk a little bit more about that.

my mother-in-law, not only does she, she contributed, she's an artist, so she contributed to a lot of the art in the clinic, but she also in her retirement, makes handmade soaks and lotions, lip balm. She makes a lot of different products, but she, she's, we get them at cost from her and so then we, when we sell them, the profit goes to the patient assistance fund.

Also. We haven't had a, a lot, Christmas time is bigger and I think we need to promote it more at that time. Cause people really love the products when they try 'em. But, but we're all kind of uncomfortable selling Also , I think that's the other, the other issue just, we're not, I mean that's part of the thing too, like going back to the whole thing about Dppc, you have to, you didn't go in like, I went into meth cause I didn't wanna have to sell anything.

Right. . Right. And, but we do, I mean, and we do end up selling a lot just in an everyday practice you're selling. Preventive care essentially. Why you trying to encourage people why you should get your, your colonoscopy, and that's a form of selling. But, but really, when it's our business, we have to sell those business to our patients, to public, to employers and to it.

It's easier to sell it when it's like we really like, it's our, our care. Hard one to soap for lotion, but . Yeah. Not I'm totally planting a seed, but when I was looking at your guys' website, even a, a passive way to have people have the ability to purchase, especially during Christmas time, if there's a, an Etsy store that your mother-in-law has or something like that, it would, it would.

Take the the sales mini part of it out and allow people to still buy the things and support the assistance fund. And on that note, I wanna ask in terms of when a person is benefiting from the assistance fund, Sherry, you mentioned like pap smears, skin biopsies, How do you identify those people who could benefit from the assistance?

But that's, Beauty of DPC is you generally know the financial picture for your patients. And so I will offer it when I know I have a patient who's uninsured and who is struggling financially already. And I just take that off of the table and I say, I want you to do a pap smear. We'll cover that for you.

And most of the time they'll say, Oh, thank you so much. And they're usually very grateful. I have a patient who, one patient who isn't technically included in a patient assistance, but she received a free scholarship for care because she is a patient of mine who is uninsured and she was in danger of, I mean, her electricity had been shut off, so I knew she had a very difficult picture, but she was a new diabetic and she really needed the care for me.

And so I offered to care for her. But I had another patient who again, really supported our practice and had already told me that he would love to pay more and give more. And so I said, Hold on to that. And I'll tap you when I need you. And sure enough, he was willing to pay for a year for this patient.

And so it's things like that that make you realize, and I think just remind me that this is why I went into medicine and this is why I am now in this sort of model because this is truly a community service that we give to our patients, but it really is the right way to practice medicine. And when I see patients helping each other out, I mean, this is what we're all about.

And so it really invigorates me about our, our clinic when, when that things like this happen. And you don't need a billboard to, to make that, make people aware of that in your community. So amazing. Yeah. And then when we talk about the, the, the fact that you guys opened up in a community that you live in, that you wanted to continue practicing in. One of the recent partnerships that you guys have created is a partnership with Dr.

Michelle Peterson, who's a pediatrician. So can you please share how even going beyond the three of you, you guys have paired now with a, a fourth physician to help your community get the care that they need.

So I think sort of a small world it, we often joke that St. Paul is St. Small cuz it's . Everybody knows everybody and everybody's connected. So I think how she heard about us was through. A friend of hers who worked at Health Partners who did coding. Is that right? For Yeah, she was our coder. Yeah, she was our coder.

Wonderful person, . And so she heard about us and she had actually already opened her own direct care practice, but it was mostly doing at home or home visits. So she was traveling and she focused more on kids with complex needs. And I think, I think she opened right before Covid happened and so hadn't grown a ton during Covid and so she was sort of trying to decide what to do and had decided to like expand into just general pediatrics and then also heard about us.

And so she kind of approached us like I. Anyway, just to let us know she was in the, in the, the neighborhood and all of that. And it so happens that we, Anita takes care of 12 and and older, and then Sherry and I are internal medicine, so we do 16, 18 and older. So we had families who have little kids and wanted direct care, but there aren't that many options.

And so when she kind of approached, we were like, Oh, this makes perfect sense to sort of join forces. And we happened to have an extra exam room and so it just kind of just came together that we would, She's not a. Full like partner in the llc, but she rents from us two days a week and we talk to her or talk to our patients about who have young kids about her and vice versa.

Her, her families that, that she takes care of. She also lets them know about us for adult care. And so it's just been a really symbiotic relationship and it's been fun. Awesome. And when you mentioned the LLC and just her involvement, I I, and I didn't ask this earlier, but when you guys created the clinic together and then now bringing on another physician to help support what you're doing and your patient's families, how does that all work legally in terms of, are you guys all co-owners of the LLC and then she is a 10 99?

How are you guys working together legally? I think, yeah, we are all partners and it's a professional llc, that's what it needs to be here in Minnesota. And uh, so she's actually just renting. She has her own separate practice and so she's just renting our room. So, and, and she has a, we have her on our website as our resource, but, but it is something that we've thought about.

If we were to add physician to our group, how would that work? That was one of the more complicated things we had to do. And we had to use a lawyer to create the, our LLC and know there was a question like llc, partnership, those legal issues, , that was all new to us, but that was the most com cause that's much more if you're single, a single doctor with your own solo practice.

It's much. Easier. You can just do that through a website, even to create your own llc. But for three people, there are a lot of different contingencies and how do you site, We all, we all put in a certain amount of money each month and then we're paid by our own patient payments essentially. And then we split our costs, otherwise three ways.

The rest of the operating expenses. And you have to kind of outline all those details and then what to do if someone were wanted to leave the practice. All those things have to be kind of planned out in the operating agreement. I think if we were to add someone That were, it was an actual employee.

we'd have to work out those details and we probably, that would be something different than having someone join our partnership. But for now, she's really an independent practitioner who really kind of just is, has a relationship with us and it's nice. It, it's, it's really nice, but it doesn't, like she takes in her own money, uses her own supplies, pays us for the space she uses.

And so we didn't have to get into a lot of thorny details or whatnot. But the one, I mean, one interesting point in a group practice like ours where we're all co-owners, one of the things I think that made it feel more comfortable when we started was that we worked out a way we each make what we bring in from our own patients.

Right. So in that way it makes it. Easy to some degree cuz it's not as though we have, we all have to be paid the same or work the same, or if you wanna work more, you can and you. So that's really been nice cuz we're a partnership, but we also have a lot of autonomy to work the way we want. And as you are highlighting something unique about your setup and how Evergreen is operated, I wanna ask for others who are considering a partnership, what other tips would you have for those people if they're considering a partnership in the near future for dpc?

I guess if I could go back and do it all over again, I would maybe use. I would do more research in what lawyer I would use, but you can spend a lot of money on a lawyer and if they don't really understand D P C, it can take a lot more time than you would imagine just to sort of explain and, and, and all of that.

And for lawyers, time is money. So I think that would be one thing. But it's hard in Minnesota that I don't know that there were a lot of, there aren't a lot of lawyers that know a lot about DPC and Keen Atla or Keen Josh Umbers father was really helpful for us, but he's also not a lawyer in Minnesota and doesn't know Minnesota law.

So we felt like we needed some help there. So that would be one thing to think about.

I think for me it was just more of just making sure that we are all. We share a lot of the similar, that we're all similar but also unique enough where we weren't going to have big personality clashes. Cause like as much as we have our own time and space, we also all share a business and we are also the face of our business.

So for us, I think that for me that was important, but I think we understood, or we saw early on that I think we would work well together. And so for me that was a big piece because besides my family, they were gonna be a big part of my life.

your work sisters. So, Yeah, absolutely. And Anita? Yeah, I think, I mean, finding the right people is huge. Um, I would say just like in terms of specifics, we made the decision to to not to just divide up expenses. Three ways and not like for every supply you use or to, to not worry too much figuring it's all gonna work out in the end.

Cuz there's always, But we keep raising it issues as we grow. Like, okay, are things still fair? Because like someone has maybe more patience, they might use more supplies. Is that still fair? Someone's malpractice is less expensive than in others and so we have to keep addressing those issues. But just being open with it.

I guess the other big thing we do is we have a meeting every week. A business meeting hour and a half over lunch, where I think that does help too. It helps us keep just the dealing with the issues as we go that have to get done, but also it's good time to just check in with each other and making sure it's still going well.

Where we wanted to go. Does anything need to shift? We need to do something different. And just being sensitive to, It's gonna be different for all of us. We, well have different goals too. We also have different financial responsibilities and so just trying to be really mindful that, that we are different in those ways and we wanna be respectful and we want this to work for all three of us.

So One of the things that the three of us figured out eventually, because I think with the three of us were like, . Okay. When I go on vacation, I'll still manage my own patients.

I'll still address my own calls. And then I think Anita and I went on separate vacations. We were like, Okay. I, I, I had to tell my husband, like, You go in with the kids. I'm gonna sit out here. I have a five minute phone call with the patient, put in some orders. I'll come in and join you guys. And it was like, Hey, dude, that every day here and there.

And it was like, Okay, this isn't. This isn't the vacation I was envisioning. So then just in the last few months, we kind of developed this support system when we're on vacation about like we are each gonna give each other a week of support that we will offload all your day to day, your fax inbox, your, any patient calls that I will, I will cover you completely.

So you can sort of be, you can hang up the, the clinic hat for that week and really enjoy your vacation. So I think that's been really nice and we wouldn't be able to do that if we didn't have this group practice. So for me as a mom, like that was great to experience that cuz I just went on vacation with my family to the Vegas, California for a week and I didn't have to worry about my patients cuz I had my two partners who were stepping in to take care of that.

So that was, that was a game changer for. And we does another one where we're trying to figure it out. So at first we were like, Oh, well, like do you, will we pay each other when we go on vacation? Like for each person you see, we'll have a certain amount that we would pay each other. And then I think eventually we came to well, and, and we'll say everyone gets two weeks.

Everyone has to take at least two weeks completely off, and then we'll cover each other for that. And you don't have to do any additional compensation. I think we might need to expand it more than two weeks, but, but as long as we're all doing it, and I think that's a simpler, stress-free way to, to do it.

And yeah, it's makes a big difference. . Mm-hmm. . And the, for the listeners, you might not be able to see it, but the smiles in all their faces is just amazing. and When it comes to potentially adding another physician to your practice or helping the movement grow in Minnesota, how are you guys contributing to direct primary care in your state?

Well, we are trying to create a kind of association of Minnesota DPC doctors, and so far we've. Three times I think we're trying to meet every quarter and it's, it's been great because it's a chance to see how other people are doing things, share resources, just have some camaraderie. And also recently doctors who are sort of curious about DPC or thinking about starting a DPC practice have started coming.

And so that's a, a nice way for them to, to sort of meet us and, and see what's happening and get some support. We have a resident coming too. Yeah. Yeah. Part of the group. Yep. And how do people find out about these meetings? Do they contact you through the website? Do you guys have a website set up for this particular organization or network?

We do have a Facebook group, And the email list. Awesome. And Sherry, for the audience, can you say what the Facebook group is? Yeah, if they just look up, um, mmn, DPC docs, they should be able to find us. Perfect. And I'll include that along with the other resources that you guys have mentioned in your Accompany Bog.

It's been such a pleasure to speak with you guys and to hear where you have come from and where you are at today and where you're going in the future.

Thank you. Thank you. It was a pleasure.

*Transcript generated by AI so please forgive errors.


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