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Episode 105: Year 2 In Review - A Reunion With Dr. J. Mutch, Dr. Mundkur & Dr. Hughes

Direct Primary Care Doctors

Last year, the following guests shared how

year one went for each of their practices and today we get to hear what’s happened during year two. So, if you want to hear about their beginnings, check out their previous interviews below.

Dr. Jake Mutch and Dr. Christina Mutch both attended college at William and Mary and then went on to attend the West Virginia School of Osteopathic Medicine. With the realization that the rushed, seven-minute visit did not provide patients or doctors with adequate time to make meaningful lifestyle changes needed to control and reverse disease, they started Defiant DPC in Williamsburg, VA in August 2020. Dr. Jake will be giving us the update today on how things are going at Defiant including how they have adapted to life as they welcomed their first child, baby girl Isla, in September of 2021!

Dr. Deepti Mundkur is an internal medicine graduate from the University of California, San Francisco School of Medicine Fresno Medical Education Program. She hails from a small coastal town in India where her medical schooling was at Manipal University in India. To meet her personal and professional goals in primary care, she started her DPC, My Happy Doctor in San Diego, CA in July of 2020 where through telemedicine and home visits she is able to care for her patients.

Dr. Lauren Hughes is a board-certified pediatrician and lactation consultant, or IBCLC, and founder and owner of Bloom Pediatrics and Lactation. She provides all general pediatric services, as well as breastfeeding services to her patients in Kansas City, KS where she was the first to become a dual IBCLC and MD in the state of Kansas. Dr. Hughes is a wife and mother of Calvin and twins Nolan and Sloane.


HEAR THEIR BEGINNINGS! Previous My DPC Story Episodes:


Dr. Jake Mutch:; Defiant DPC - Williamsburg, VA

Dr. Lauren Hughes:; Bloom Pediatrics and Lactation - Kansas City, KS


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Listen to the Episode Here:




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  Welcome again to my DPC story. And thank you so much for joining

us today, guys. Thanks for having me. Appreciate it. Thank you for having us.

Happy to be here, Maria. Thank you.

With you guys coming back on a little over a year since your last interview Jake and Christina Christina's unable to join us today, but your daughter is past one now.

She just turned one in September. And Lauren continues to have three amazing kids who are teenagers, and DTI has another puppy in her life. And so, life continues to happen as your DPCs are growing. So, can you look back on this last year and give us, give the audience a feel as to the theme of, what, what has transpired over your year?

Ooh. Yeah. I would definitely say this has been a uh, year of growth. It's been a huge learning experience and I've been really grateful for the practice because it's allowed us to have enough flexibility so that we can, if baby is sick or something and we need to rearrange the schedule, it's not this whole affair. We can literally just move the pieces really smoothly.

And so that has been absolutely wonderful. If I had to put like a, I guess a. Theme for the year, It would probably be either hospitality or team building. We've really, I guess, rebranded or changed our, our, we've renovated the actual practice as well as a little bit of the website to really make it clear that what we're trying to deliver is a really high touch, very accessible kind of care.

And that we wanted to make hospitality that core theme to do, that we've been building on the infrastructure that we had in previous years, where before it was about setting up video workflows for virtual assistance or those kinds of things. Now it's really about, okay, how do we bring on a team to be able to make sure that we're delivering the kind of care that we dream of, of our practice being.

And so we do that in two ways. And we're extremely fortunate because this has been very much a process of, of hiring people. And so we have two just fantastic assistants that we've been working with. There's one that's a virtual who functions as an operations assistant, and then one who's in the office who is a clinical assistant.

And so that's been amazing because like our operations assistant is kind of working behind the scenes. She has a lot of hospitality experience and like healthcare fields, and that's been amazing because it's, everything from chasing down records and, third party interactions as well as helping patients.

For some reason, the pharmacy doesn't recognize that the prescription has been filled or whatever. She's really our, our bulldog for going after all of those things and it really helps keep the patients in the loop for what's happening. And then and we actually, so I'll tell you a quick story of how we discovered her.

So basically I was trying to fulfill like an online coffee order for my for my wife. And uh, this was while she was pregnant and she was the, the head barista there. And so I was going to fulfill that coffee order and I put in just like what I thought I want, ah, like blah, blah, blah as baro, it'll be fine.

And then I get a call 30 seconds later and she picks up the phone, she says, Hey, I just wanted to be sure, I didn't wanna step on your toes or anything, but I noticed that the drink your wife normally gets doesn't have this extra like espresso shot, whatever in it. Are you sure you want me to fulfill this order?

And I said, Oh my goodness. Thank you so much. And I just kind of filed that away in the back of my head because anybody with that much like work ethic and integrity, I definitely, if there's ever an opportunity and one arose and I said, Absolutely. We've gotta, we've gotta happy on board. And the final thing that I'll say is a clinical assistant, basically that scribes that greets the patients at the door, escorts them over to our suites and processes, labs, and also functions a little bit as a, like a medical library.

And she's got a research background, so she does a little bit of research, bef like, gives me briefs on everything and then sends it over so that I can counsel patients and kind of give them a table of contents that those things have really helped. I'll make sure that I can dedicate as much time as possible to the patient care.

And that's because we've built up this like protocol for how things operate and we evolve that over time. So we're incredibly lucky for that. And that's, that's kind of been what our, our process has been about. So,

so exciting to hear that update. How about you, DTI or Lauren?

I would say my theme has been adaptation probably. So I have had to and end boundaries. I've grown significantly this year and I have reached the capacity of what I can handle myself. I have decided that I'm gonna add on another physician just because I, I had to take down my meet and greet request off my website because I couldn't tell people no

So removing the request was like the, the boundary I had to set. I couldn't like talk to people. Get all my feels and then create a wait list and then tell them, No, I can't take care of you. Um, And so I had to just, I had to close that down. Adaptation with my kids too. . Um, My, let's see, So my oldest, I agree with Jake that like the, the flexibility and the adaptation part, like we will lose childcare for the day cuz somebody's sick when knee and he's sick or whatever.

And my kids are now old enough that like I just bring him to the office and they run around and my patients like, I just text him or I'm like, Hey, twins are gonna be here. And it's fine. And most of my patients, like most of the parents, like, are excited to see my kids. They hear all about 'em all the time.

I have dabbled with the idea of, of adding either like a staff person, like. I don't know, like doing a VA or a, something like that. But I just, I've never pulled the trigger. I'm just not good at handing those things off. But it's been great. Like I'm, I'm done seeing patients for the day.

Yeah, it's just Fri and Sweet

And just to put some context to that, it's only nine 40 Pacific. And so when Lauren's done for the day, she's done for the day in the morning. So it's incredible.

Yeah. I've finished with 1115 this morning. My time, central time, like I saw four patients and I diagnosed, let's see quick hand, foot in mouth, a parvo, a well check, and then a tongue tie revision, and I'm.

That's awesome cuz it almost sounds like you got your boundaries . I finally did. Yeah. It was, it was, I had to remove access from non-patients because I also have, I'm full, but I have I think eight babies coming in October and all siblings. Mm-hmm. . Cause I've now been old, I've now been open long enough that my new babies now have little babies coming

So it's, I'm just, so, I, yeah, it's just great. And I would love to have another doc too, mainly because I, the one thing that I have missed is the ability to be like, Hey, I saw da, da da, what do you think? ? And like, I was gonna go ahead and do this. Like, does that sound okay? And Yeah, definitely.

Um, So, with me, the way I started the whole, My Happy Doctor journey was pretty much at my lowest point where I just felt like, why did I choose to be a doctor if this is how life feels like being in the insurance model?

And that was just six months where I almost felt like I, I, my safety at work was threatened. Because of some abusive situations where patients were demanding for certain medicines that I shouldn't have been giving them. So, it went from being like this super low to then having the dream of my happy doctor evolve over like a couple of months and then actually start it.

And then there's, there was so much evolution in, in the way I interacted with patients. Cuz there's that initial like, wonder am I doing this right? Am I saying the right things during my meet and greet? Like, am I coming off as really needy, someone who really needs patients? Right. And it's and it was hard And now eventually all that has kind of fallen in place and I think.

Achieve the My Happy Doctor position by the end of first year. And then once I, once, once I started through the second year, I, I think it was more about making my happy place because now I had that that change in me that made me my happy doctor. But now I have to kind of set all the rest of my my house call situation, my telemedicine, my workflow into this, my happy place where I don't get those anxious palpitations and stuff like, which were part of common, experiences during uh, the insurance model.

Even residency we kind of expect that just because we are going through a huge, like learning. But having that happen during the insurance based practice just seemed like, a never ending ordeal, which I'm happy to announce that there's no more palpitations, happening, but, but it's, it's still very important to keep, revisiting and rethinking I think about what I envision my happy place to be.

Cause it's very, it's very no, you can see that I'm not growing to the point that I'm hiring staff. And, and that's my happy place because I feel like what I envision from my happy doctor is truly a micropractice. And I think a lot of doctors worry about having to hire someone or having to, you know, spend a lot in the beginning.

And for me to be at my two year point, getting my income that I wanted and, and just working on my. De the tiny details that actually make a huge impact on my everyday and seem, seems like the ma my happy place is what the focus is for for this, for the past year. And it just, every day is a new experience and there's some bad experience still because, you know, as a business person it's, it's, it's hard to say no is there's friends who just like text you say, Hey, Kevin, can you tell me what this European is about?

And it's hard to navigate these things cuz they wouldn't have probably done that if you weren't a doctor, Right? And so, there are situations like that, that take a little more out of you emotionally too. And, it is a journey that is unique for everyone.

And I'm, I'm glad that I've reached this spot that I'm at.

And I'm sure, especially for those people who have been inspired by your guys' journeys it's so wonderful to hear, real life problems of a business owner and a physician in direct primary care. Because it's not all sunshine, lollipops, and rainbows for sure.

Yeah. And when you guys are talking about boundaries whether it be, deciding to create a wait list, close a wait list, hiring staff focus on, creating an environment where you wanna practice, how do you guys check in with yourselves to say like, Oh, I gotta reevaluate something because a boundary has been crossed, or I'm sensing that a boundary is about to

be crossed.

I go by, like if I am starting to resent the thing that's happening are my patients texting me after hours? Are they trying to text me on weekends? Like, are they calling about unnecessary things? Or like, do I feel like th I'm getting a lot of questions about this specific thing and I'm repeating myself over and over.

So I just kind of check in with like, what is making me irritated, and then how can I fix that? So I will, in terms of boundaries, like if I'm getting, Oh, hey, there's been this weird rash for the last three months that is not a 9:00 PM text. That is definitely not a 9:00 PM call. And so then I, I send out monthly newsletters and I send, I'm like, Hey guys, reminder.

I have a family too. I go to bed too. And I, There are some important things that I do want you to call me about, but make sure that it is an urgent need and something that can't wait until morning. If it can wait until morning, please wait until morning. Um, And fa then families are amazing about our, the response is always incredible because you do have such a good relationship with them.

And families will even get onto me for replying after hours. You're like, Hey, stop it. Stop text, text me in the morning. And so I'm very lucky that my families are, are so great because they hold me accountable and hold my boundaries accountable when I don't, so I don't get burnout. And that was like the, the wait list thing.

It was causing me anxiety that I had these people that wanted me to see them and I couldn't. So I was like, I can't, I cannot have a wait list because it is, it is too stressful. So I just took it off. So yeah, it's mainly just going by. I'm a big gut person and so I'm going by my gut.

Yeah. I would say kind of in the same vein, okay, where, how do we know when a bounding may be crossroad?

Is it bound to be crossed? And how to like, set up a protocol for that. Oftentimes if it's like somebody we're talking to, I very much, wish there were some sort of protocol or, algorithm that I could follow in terms of exactly how to determine if somebody is a best fit for the practice.

But it's very much a gut feeling and it, it's, I think that a lot of people can resonate with that. You just get on the phone and like you really want to click and, and find, your drive and your people. I have found that in terms of interacting with patients, especially with things like like, how to contact me usually I'll have like the same, two minute thing that I will say at the end of every new patient appointment.

And generally speaking has relieved a lot of concerns and anxiety about how best to contact me and all the like kind of late night texts and stuff as well. And so that's been kind of helpful and a little bit surprising as well. And then, it's, it's very much just kind of that constant reassessing of.

Is this am I feeling good about this relationship? I want it to be a positive one for you. I want, like, I want this to be a relationship where you feel it's both jiving. And if it's not, then just having that upfront conversation saying, I, I feel like maybe we're not getting along here and I sense some frustration.

Is there any truth to that? And being able to be open to that conversation, at least from my perspective, has allowed them to air any concerns that they might have. Whenever sparingly they happen. But at the same time, it also allows me to have a floor to kind of discuss some things that for a long term relationship, I wanna make sure are, solid and maintained.

I feel like my overall experience is that since Covid or maybe he would, before Covid, there's been this underlying anxiety that most patients have. And with the membership model, there's extra access. So you could just get sentences like, Is everything wrong with me? Or something like that. Which , which you could just.

Oftentimes not realize what the patient might actually be, getting at. So I kind of take a step back when I get such sentences and I go, Okay, so that sounds like overwhelm. It could be, personal overwhelm or related to their health, but it helps to bring those boundaries in place at the time.

So I generally, there was one patient who, who would complain about multiple things, which obviously, they have a lot of symptoms and things have been missed in the past. So there is that concern that maybe, this symptom is actually something really bad. So when they said this sentence about, is everything wrong with me?

But there was nothing else, there was no other symptoms and nothing else mentioned on. I went back to kind of, politely, compassionately, dissect into saying, Hey, does sound like that sentence particularly sounds like there's some sense of overwhelm about this. So can we set up an appointment?

And so that particular person expected,

you know,

based on how they're feeling, they almost expected to see me every week or every two weeks, but one time that full conversation, dissecting everything, trying to, get through all of those pieces of the puzzle and then reassuring the patient went so long that, they didn't even need me for three months after that.

And so it does, help to not let those. Moments just pass by and accumulated to something where you eventually may resent them and have conflicts and, it just doesn't help grow your own

you know,

professional skills either. And so it just felt, feels like the tests that I've had with the boundaries where usually, doctors whenever they consider dpc, they go, they go, Oh my God, and the patient is gonna have access to me all the time.

Now I look at it both ways. I feel like I got access to them too. And so that's always easier when I start a new medicine, I'm like a little bit worried about kidney function and I want to retest again. I would rather they, they respond to my texts right away in those situations. And so it just feels like a good balance.

You just need to know where to compromise with some of the. Boundary related issues and it's been two years and I feel like I don't ever get a text or email that sounds like it's extremely anxious and needs a immediate response on the weekend. I don't mind if they are right on the weekend, cuz you never know.

Some people are so busy they just get the time to think about their health on the weekend. But I try to just screen really quick on the weekends to see if there's anything urgent that I need to get back to. But if it's not urgent and I have the time, I already read the email, I just schedule a response for Monday morning.

So that way,

you know,

I don't have to go through that or all over again. But it doesn't promote this behavior of, ah, she's free on the weekend and, we can just go back and forth. So there was a very good example this morning. So the patient emailed me on the weekend, extremely non-urgent issue.

I scheduled a response for 8:00 AM in the morning and at 7 35 I get an email, Did you get my email doc? And so I responded with. During the weekends be to avoid back and forth because it's, weekends are not working hours for me. I try to schedule so you'll get your response in three minutes and there, there you go.

They got, they got the response in three minutes because it was 8:00 AM in, whatever, by, by the time I had responded to them. So it just helps a lot to get them to see your perspective and down the road, they wouldn't feel abandonment or something crazy. Which, which oftentimes, it may seem very easy to judge your patients, but they've gone through, there's, everyone's going through their own story.

And overall, as long as we remain compassionate and just remind gently about the boundaries, it goes a long way to make a strong relat.

Now, looking back on this last year, what would you guys say was your biggest win in each of your clinics?

I think the biggest win was seeing this, I'm sure Jake and Lauren have also experienced this because the way DPC works is the word spreads and you don't have to do a ton of social media and ton of pounding the pavement all the time.

So I've, I've been getting a constant stream of requests for meet and greets or appointments and memberships just because of people talking to each other about it and the word of mouth and those reviews that people leave. After they thank me, I just send them a quick it's just about the timing where you ask for the review.

I feel if you send it as a regular scheduled hey, can you write a review for me after your appointment generally doesn't trigger an immediate response of writing the review. Oftentimes it's when there's this, amazing thing you did and, and there's, you're the best thank you.

And then you go, Hey, if you, if you don't mind, peop a lot of people don't know about this and I appreciate you, and if you don't write it, no problem. Um, So that way they, they feel kind of, this responsibility for the community and this sense of I need to share this so that more people can.

Benefit from it. And I'm, I'm seeing that. And that was my dream. I didn't ever want to have ads or like have, had to pay for those advertisements and social media boosting and on whatnot. I feel like the organic growth that has happened has just multiplied with time. But I do, I'm, I'm very careful about the good fit part, like Jake, Jake mentioned because the churn can be really high if it's not a good fit.

And, and sometimes, there's financial reasons that people stop the membership for, and that, that's totally understandable. But most times you want to avoid the fit being an issue down the road cuz you want to grow. You don't wanna keep having a churn.

besides a newborn baby and I, that's, I mean, that's gotta top everything. But the, for the practice, I would say that there were a couple of, I don't know, lagging indicators that we were starting to do things very right.

And that was one of the things that gives me, personally a lot of energy is being able to teach. Having the time, having the, like, the luxury of being able to spend some time with whether it's with patients and teaching at the bedside or whether it's afterwards and just going through a chalk talk with a medical student on how these things work.

Within the past year, we have. We've had a couple of medical students on, and it's been it's been really wonderful because it feels like I get to introduce DPC to people who are thinking about that kind of thing. And in addition to that, it also is kind of a, a measure that yes, the workflows that we've put in place assistance and all the things that we've built and wondered, was this actually going to work or not, has, has actually come to fruition enough that we can have that time.

So whether it's teaching a medical student or whether it's just, taking the team out for lunch or something like that, we've built this system where we can design the day as we, as we see fit for patients for ourselves and for us and for me personally, like that, that autonomy, that a sense of control over Exactly health practices run is really fulfilling.

And it makes me, very excited to, to get up and, and, walk into the practice each day. Fantastic.

And Lauren. I kind of like a bit of both of them. So, teaching, like I, right before we started, I was sending my med student home. I have med students every month and I, I am this, I love teaching.

I one resident teacher of the year. I love teaching. So I get really excited when I have med students and especially when they're like these little green, like third and fourth years and it's just it's just the sweetest. I would love to be able to get residents too. I just, I didn't even go searching for med students.

They found me. But it is, it's been, that has been awesome. And the growth factor too has been great. And like, it, it's just, I mean, I like doing social media. I think it's fun. My kids are obsessed with watching reels with like reels I've done. Like, it's so, I think it's. Enjoyable. And it's not something I have to do, so I just do it what I want.

but the right growth is, I, I agree, is like the most important thing. And so the word of mouth is my favorite way of growth because I like, I like my patience and when they send me their friends, I know that they are the same type of people. I will like them and it's all going to be great. And so it allows me to grow with the right families, and it does, it keeps turn really low.

And so I think the organic growth and the also, yeah, the autonomy. Like I didn't have any patients scheduled Friday, blocked it off, gonna take my son to the. Like, I just get to go do these things because I want to I'm, I blocked off today and tomorrow for as much time as possible so I could watch some of the AAP conference.

Like I get to just do what I want to do each day. Or sometimes I'll have days where I'm like, Ah, God, I just like, I don't wanna stay late. I don't wanna like, see patients. And so like, I will move them to the next day. Like I just get to do what is best for me. And realizing that also, I used to be scared to, whenever I was first open, to like ruffle any feathers or create any waves or whatever, and like, Oh, hey, I gotta move your appointment because something came up.

And so I would do that and I'd sacrifice like my personal wellbeing for the fear of rocking the boat and like sending scaring patients off. And now I'm like, eh, they don't. and I'd say another great win I had was I did a lot of pediatric covid clinics. It was really hard to find Covid vaccines under 18 months, and I was like, one of the only ones at Moderna.

So I did tons of, of Covid clinics, and shockingly, the first people through the doors for the Covid vaccine were doctors, kids. And it was a lot of discussion. I had tons of discussion with other family docs, internal medicine dogs, pediatricians, who were like, So how do you do this? And so, at the very least um, I, I got it in their head.

Oh, and I guess so a personal win. My newest resolution was to find my own doctor. I, I've never actually been to the doctor in my life except to have kids. Like, that's the only time I've ever seen a doctor. My ob when I went in with my twin, she's like, When was your last path? And I was like, My, what?

What is that? It's fine, It's fine. Really a really good patient. So my, that was like, my usual resolution is I was like, I need a pcp. I probably should get like labs and like be the patient. So did, and he is opening his own DPC at the beginning of next year because he was like, You're just happy.

Yeah, And so he is transitioning to DPC and like went to the summit, all this stuff. That's

awesome. Love it. And now on the opposite side of things, you guys had mentioned boundaries and you've mentioned ways that you have pivoted.

But in terms of one of the biggest opportunities that you guys have found either to grow or to change your practice, can you give another example of what you've, what you've done over this past

year? So I changed EHRs.

That was a huge, Hm. That was not enjoyable. And it was expensive, but I, one of the things I realized was how. Steps I had to take to do something and how many clicks it took and how many tabs I had to have open to like, do all these things. And the, the final straw for me was I had been paying my EHR for two years to upload vaccines to the registry.

Which was a legal requirement and I discovered they had not uploaded anything. So I have two years of vaccines that I am still going back through and inputting. So I am in compliance . Wow. Yeah, and I'm a VFC provider of vaccines for children providers. So like I have to, to maintain VFC status. And they, they didn't do they, and it said, submitted, completed, completed submission to registry in my ehr.

So like, I never questioned it. Until, Yeah, so that was, that was the final straw for me. So yeah, guys, double check that people are doing what you're paying them to do. But when I switched EHRs, it was awesome because I, my texts are in the chart, so I don't have to go through and copy and paste texts into a note anymore.

My fax automatically gets assigned to the patient, so I don't have to go through the, Hey, I faxed blah, blah, blah on this day, it's already in there. So then I don't have to go back through and like, what did I say in that letter? What did I say in that text? And it organizes my text by like groups.

So I'm like, Okay, yes, this text session on this day because you were sick this day. And so it's all there. And it does all my billing and all that stuff. So it's, everything is in one place, which has freed up my time. I did not realize how much time it took to go through and do all of these steps individually.

And that was, I think, my biggest. Opportunity that I didn't anticipate, but was a great thing.

I think mine was, again, because I'm a micropractice and I, do not envision myself having staff right now, I just push my limits with looking for workflow opportunities that make my life easier. I. Definitely have pay more time for how much I make , the, the whole ratio of time spent versus how much you actually make because of membership model.

The whole point is to be there for your patients when you, when they need you. But that doesn't mean they need you all the time. So it just happens to be some patients using you a lot of times for the month versus then for many months they won't need you. So I just want to kind of remind about that because that makes my.

Workflow important. When they do need me, it's really quick, quick, quick stuff. I don't want to sit and type a bunch of things. So over the two years, every time I've repeated myself about something, I just created this nice little response and I've used macro, I think it's called Macros Pro or macro tips or something like that, which integrates with my keyboard.

I did try try text replacements, like you said, maryelle, but some of those, they need to be like a really long responses and I don't think they would fit into the text replacement that comes as a. In, in the inbuilt within the iPhone. But my macro tips was, is really useful because if I send a prescription, or let's say the most common ones are prescription sent, checking in did you, did you get the lab order that I sent?

And quick stuff like that I want to just check up on. All of that is within my keyboard. And so I just go click, click, click, whether it's in an email or a text or, through my, through my emr. As long as it's in the keyboard, it just goes straight in and I can just edit few things like prescription is sent to this pharmacy and just write down the name of the pharmacy if they keep switching sometimes between pharmacies.

And so it's so much easier. I felt like I've been on the go and managing, not just like when I was, when I was flying back from Canada on a trip recently and I had to order a CT scan cuz. We did an x-ray and there was, the patient was coughing out blood and I really wanted to make sure there's no, cavity or anything in the lung.

And so went ahead ordered a CT scan on the go from Seattle Airport because everything is set up on the laptop to just be click, click, click, click, click, and the fax went through. And so the experience that patients get is exceptional, but at the same time, I'm not beating my head about it.

It's happening. , in a very convenient way on the go. And, you know how much I've traveled the past year for, for various reasons, for fun and al also for responsibilities. But I feel like it was possible because of those workflow management that I did, and it might seem really simple macros but you won't, you won't imagine how many times you have to use them on various patients because it's oftentimes lab testing or imaging or prescriptions.

Which is kind of, the three tools in my, in the surgeries I perform , which is literally, literally being internist. That's, that's mostly what you need. Yeah, I, I think that was, that was pretty much what I focused on this year and has been incredible.

I definitely resonate with that because oftentimes we don't really take note of exactly how much time a task takes until we, do an inventory evidence, say, Oh wow, it's, it took me, 15 minutes to send out this lab reporter or whatever it is, or 45.

It was really complicated and you. Things were all over the place and we got a whole bunch of labs. But honestly using macros, whether it's for, an exam or, or something to make it easier for ascribing in the future, whether it is here's a, the common labs that I order and what they mean, and then I can just pull in exactly what the trend has been, and that's what we're doing about it afterwards, the patient gets this really nice, very detailed.

Report of what's going on from my perspective. And then we talk about future follow up. One thing that really helps um, that we just kind of unlocked, I would say within the past few months is that instead of setting a reminder to ask the patient about the labs, we just schedule a text that says, Hey, you're due for labs.

And we put it 90 days, 180 days, whatever it is in advance. And that way it's on the record. We're, we're, we are reaching out to them. We're saying, Hey, if you wanna go through insurance, just let me know this. It's kind of like an auto text or just say yes if you want me to put everything in the way it was before.

And it makes things a lot simpler because the task list isn't building up and patients are still getting, attended to and cared for. The final thing that has really helped. I think I may have alluded to this before, is that we make our communication policy as well as our what exactly patient care navigation through our operations assistant looks like.

And so at the end of the visit, I say, Okay if you are, if we're putting in orders, prescriptions, anything like that, and you're having any trouble getting this through, here's the direct line for our patient care navigator. She will, go in the hunt for whatever needs to be done. She report back to me and you can always, feed me into that as well.

And I'll make sure that that's taken care of. But the real most beneficial thing that I've seen so far, Was talking about the the patient communication policy. And so it's a 30 or 62nd thing that I say to every single patient that's cut down on a lot of confusion. A lot of like afternoon texts and stuff.

And so, what I, what I typically say is so you may be wondering like how to get in contact with me. Um, Here's my private card. It's got my private email, my private cell phone on it. There's no dial six for the call tree. There's no nurse line. It goes straight to me. And so if something's going on during the day and you have a concern, Feel free to call a text or email.

If I'll try to get through it in the, in that business day. If you're concerned about, certainly call and leave a voicemail. If I get that voicemail, I know you didn't butt dial me, so I know you want me to get back to you and I can definitely make sure your resources are, are allocated appropriately.

We get that taken care of for you soon as possible. If it's the case, we're open these hours to these hours on these days and these days, and then if it's the case that something's happening after hours and it's an emergency, of course, that's 9 1 1. If it's just Hey, my blood pressures are are normal and things are going great, feel free to text or email me after hours.

I will see those the next business day. Make sure we get that attended to. And then if you're not sure, if you have a fever, an abdominal pain, or you've gotta cut and you're not sure where to go, definitely give me a call because what I can do is make sure that that thing gets worked up appropriately. So for an example, if you go to the urgent care and you have this thing going on, the urgent care will see you, they will bill you and then they will send you to the emergency room for that CT scan they don't have.

If I know what's going on, I can make sure we marshal your resources appropriately and get you to the right spot. And then from there, I guess, while we're not, legally, technically on call, I was raised the old fashioned way. And so if something's going on with you and I happen to have my phone on me, I will make sure and like do everything I can, make sure you're, you're cared for.

Any questions on how to contact me. That 30 or 62nd or whatever it is, has, has gone a long way for clearing up any potential opportunities for friction. And then when I know a patient texts me or emails me over the weekend, they're not expecting that to get followed up for. That's what the phone and been being put on emergency bypass for their phone is.

Awesome. And I'm sure those that your tips have continued to help the people who are listening and tuning in and being inspired by your stories. Now, when we talk about our practices there's always something that happens where you're to another physician, talking to a resident, talking to a medical student, and or even a, a future patient.

And you're like, You would never believe that this happened in my practice. And the only reason it happened was because I do direct primary care. So, can you guys give examples of things that have happened over the past year where it's a you wouldn't believe it if type of


I think mine, the biggest one was a patient traveling internationally to get testing done in an affordable exact pricing before the patient went through all that. So she knew how much she would be spending on the flight, just like she knew how much she would be spending for the labs and my appointments.

So I've heard of these things happen with like, oh, patient, fancy politician patient come to Mount Sinai for like, some cutting edge therapy, but you wouldn't think there would be a patient coming for affordable and predictable care from Europe to, San Diego on vacation.

And get testing done. So that was actually a really incredible thing, which I don't think in any insurance based model, I would've come across a patient look for me and come specifically for what I'm offering. And that, that, that's incredible. And it went through really great. And it just still is, is is really, Yeah.

I, I would say a matter of pride, but I also it makes you really humble. Because you then realize there's a lot of people who need this. There's so many countries who don't have access to care. And a lot of people ask BPC doctors, Oh, but you don't work for free.

Oh, then, then you, you're charging membership. Right? You're not free. So why are you, why are you charging extra when I have insurance? Well, there's a lot of people who don't even have insurance, and I don't call myself like some sort of a messiah or something. Right. But I, I think we have a role to play. We have a role to play.

There's a lot of uninsured patients in the community, and it's not all about the people who are insured.

Yeah. Definitely I can think of two examples that were really accredit to what DPC is able to do for patients. I think a lot of our patients lot of patients in general who come to DPC have had a really negative experience in the healthcare system.

They've been very difficult time with care coordination, with getting the things that they need, and things just feel kinda left by the wayside. And so as a result, a lot of patients feel like they're trying to hold their entire health history and health maintenance on their own shoulders, and that's extremely anxiety producing.

And so, One of the things that we try to do is if there's any way that there that we can eliminate confusion, that we can coordinate care a little bit better, even if it's a little bit unconventional. We certainly will. I can actually think recently there was a patient, my wife had and she was having like a little bit of a miscommunication with like, what is the next best step from for oncology for this particular thing?

And it's kind of off the beaten tracks in terms of what the guidelines say. And we wanted to try something a little bit different. And so, initially it wasn't clear based on the patient communication and like with the specialist that things were going to proceed the way we hoped. And so what Christina did was asked if it was okay to phone in and sit in on that oncology employ.

and it was just, thank goodness that she did that. I'll tutor her horn a little bit. Because the receiving specialist for some reason their their EMR or whatever went down and so they had no notes to go off of. They had no anything. And so she was able to provide that that kind of sign out and give some ideas.

And it ended up having a really good outcome for the patient. And speaking of things not working correctly I actually had one recently where we kept sending an EMG order and it was going through, I could see in the emr, I sent it a million times. Our assistance were also working, coordinating just, it was not going through what we called, we sent it while calling, like so many different things.

Eventually we just said enough. And so my clinical assistant she printed out the order and she hand delivered it to that office for two of our patients. And and it's one of those things that Wish we didn't have to do things like that. But unfortunately, the healthcare system is run on faxes and all these antiquated things, and so you gotta do whatever's necessary to make sure your patients are getting the best possible care.

And so that's those are some big wins that we've had recently. Because it, it's so easy for things to get lost in the system, and part of DPC is, is ensuring that that stuff doesn't happen.

So I've had of a, a pretty medically complex patient that he, his mom was referred to me by her therapist and I actually got a call from the therapist that was like, I want you to know that just by being a central person and advocating for him, like. She was like, I've never seen her succeed this much in therapy.

And like, so that was like, just knowing that my ability to just send orders immediately and like he needs constant home health nursing um, approvals and notes and changes and and stuff. And she used to have to call and be like, Hey, I need you to sign this. We run out on the seventh day. I need you to sign this.

And so she just doesn't have to do that anymore. Mm-hmm. . So like, things like that. That was really cool. And then I had one kid that, because I know him so well, saw him after he'd had a seizure. And I, they came to my house cuz it was Halloween. This was last year. It was Halloween. So they came to my house.

They were, they lived close by and they were already in the car. And so I was like, Yeah, just come over. You don't need to go to the er. I'll look at 'em. So like, I have my home bag of stuff. So, My kids were napping, so it worked out well. Like checked sugar, looked at him did a neuro exam. I was like, eh, he's fine.

This was probably just febrile seizure. So, and, but told him was like, Hey, we need to, this is what you watch out for. He has another one in 24 hours, blah, blah. So I was like, You need to go to the yard. Had several more and he was had several more seizures and was seen in the er. And they only consulted neuro neuros in the middle of the night, so they didn't come in.

And then the neuro, I called neurology on call and it was a, I think it was like, I don't know who it was, but it was a fellow or resident. He was like, Yeah, just start 'em on Keppra. And I was like, I don't start kids on Keppra . Like that's not my thing. And so then I was very frustrated. And I know be, I know this kid's personality and he was not acting right.

I called the attending, the admitting attending cuz I know her. And I was like, hey. Something's wrong. Got a direct admit, and he was having frontal lobe seizures, like subclinical. And it, I just, I think I'm like, okay, the fact that like, I was able to have these calls, it, it was phone calls, right? You can do it from anywhere.

I was like making my kids breakfast and I was like getting the, and I was getting him a direct admit. And like I was calling mom, they're like, Hey, this is, I was like texting her as I'm on the phone. I'm like, Hey, I'm on the phone with neurology. I'm telling her the story. She's talking she's gonna admit him.

This is what you need to do. And just the level of like the expediency is incredible, but just the fact that like got him in. Yeah.

That's awesome. Yeah,

it's, it's very cool. All because of

practicing as direct primary care

physicians, because I have, the time that I knew this kid was not acting was not, it, it wasn't, mom was being crazy.

He was not acting normal. He was, I've known him for two years. He was not acting like himself. .

And I just wanna highlight again because you are direct primary care physicians and because you have a membership model and you're not being paid by number of head seen per day, you got paid to do those things because there's no code.

I don't know what code to use To represent all of that work and that dedication and that tenacity that you guys show every day and why people found your value proposition ne necessary.

So on that note, I wanna ask about pricing. Have your guys' pricing structures changed over the last year?

Yes, our our pricing structure did change. Initially the prices that we had were as a thank you to our inaugural members. And then as our practice began grew, we grow, we really wanted to consider, okay, what are the features?

What does our dream practice look like? What are the things that we wanna be able to bring to the table to offer patients? And then how do we back calculate and make sure that that happens? And one of the things that we realized was it would be really great if we had like, the best care coordination we could possibly have.

And we realized that having assistance to help with logistical and clinical concerns would. Would be able to do that for us. And so, as we adjusted what we were able to do is really focus more on hospitality. We were able to make sure that we have a, a well compensated staff a series of assistance who are bringing their, their a game every single day to work.

And I wanted to make sure that they were sharing in that growth, that they were being, that we were creating a place that would be a wonderful place to work. And so, being compensated is, is part of that. And so I wanted to make sure that we build that team together. And so we had to think about it and decide, okay, exactly how do we wanted to make this.

We ended up going ahead and increasing our prices, and we had the same for for children and adults. And we haven't looked back since. It's allowed us to provide a five star level of hospitality and coordination of care that we really wanted to make sure that we deliver so that we can feel good about the medicine that we're practicing.

And so it's been great so far.

So there's pros and cons to changing the pricing. I feel like if there is some amount of churn, a few patients leaving each month, if you have a larger price, then every time a patient leaves, that's how much you'll drop on your income.

So it does make sense to find that best fit where it works out for you to, have that churn and still not, be vulnerable, losing income. But at the same time it should just be the right amount that you would make for seeing the same patients same number of patients. A goal, number of patient.

That you can actually handle perfectly and while not com compromising on the quality of care. So we know DPC is not incredibly scalable because it involves actual physician time. And so, it just seems like even though I had started off with a really low price, like I think some of my discount members in the beginning were like $35 a month, which is really incredible amount of.

For a doc directly with a doctor for almost 90% of the care. And so it went from probably five, seven patients having access to that to the youngest patients being $50 a month being the lowest price for the, non discount pricing. And then over the years, now it's come to 1 29 a month and 1 59 a month.

And the reason being, I feel like the amount of effort I put in and for the number of patients that I see it is still very affordable for how much they get patients get. And I don't want to increase the price any further for the foreseeable future just because of, inflation and everything's expensive.

Like even groceries are expensive. So I have to kind of factor in that for my own the sustainability of my practice as well. Cuz I don't wanna be. Having all this pro progress and then going and finding a part-time job to just make this work. So it just seemed like the best fit to increase the price slightly.

And patients, actually, it's, it's kind of weird. Patients actually take you more seriously when the pricing is a little more palatable with, or comparable with the rest of, how much an electrician would charge or a plumber would charge. And suddenly you don't seem like this farfetched tele telemedicine company and you actually become a legitimate like person who you have a doctor patient relationship with.

So it, it did help but it happened very naturally. I don't think I spent a whole lot of time thinking about the pricing. It just happened so that, I felt like the, this price range was mostly the, the best fit for my practice as well.

and I, it is I, I know a lot of people have commented on this sort of thing before, but it, it is very much when somebody is a prospective patient and they're calling and trying to figure out if you are if you're who you say you are, and if you do what you say you do, and that conversation, it's built on trust.

And so if you're offering a large value proposition I want to make sure that, that that's acknowledged. And at the same time, I wanna make sure that I'm delivering everything possible for, for my patients. I have found that in our area, when you're talking about, so the counterargument is like, aren't we approaching concierge?

Aren't we like doing something that somehow is counter to the dpc? And what I would say is if you've seen one dpc, you've seen one dpc, there are so many different ways, whether it's fo focusing on, old fashioned doctoring to, the cutting edge, integrative, this and that, or whether it's affordable versus premium.

There's so many different ways that you can make your message resonate. And, and, and just briefly, like, especially when I was having this conversation with patients sometimes there'd be a little bit of confusion because it's like do you want to, They, they think it's like, okay, this is kind of like concierge, right?

And and part of me as a DPC doctor and all the baggage that comes with what the word concierge means, and these kinds of things. Before I used to say, Oh, no, no, no, we're not, we're nothing like that. We're this thing and this is new movement, like 1500 we're 600 practices and we're all independent and this and that.

And really, I, I think that that was actually a disservice to the message because what they were asking by saying concierge was. Are you accessible? That's what they meant. And so, when I kind of removed my own baggage and said, Yes, we're like concierge, except we don't bill insurance and we don't do the annual fee thing.

They say, Oh, okay, perfect. It's so few logical leaps to go from what they understood to what we do. Yes, absolutely. That, that totally makes sense. And it ended up being we didn't have to kind of pull them back from, they didn't have retract at all during that conversation. We were able to say, Yeah, let's go ahead and move forward with an appointment and talk more about this.

And so that ended up being really useful because. Some of the challenge here is making sure that people do appreciate and value what you do, that it's sustainable for you. But at the same time that when you have that conversation, it doesn't lead to any kind of shady, like, questions about, Okay, well how are you doing this?

And, how are you able to provide all of this? And people still feel that way even with an increased price. Like, I'm like so blown away that you can do X, Y, and Z and I think a lot of DPC physicians have gotten that feedback before. And so I'm still convinced and committed to the idea of an affordable membership and making sure that that makes sense for people and makes sense for me.

But it also, again, it's allowed me to increase the quality and that's what I've doubled down on the hospitality and that's what patients have come to really truly appreciate.

I have raised prices. Yeah, I think I'm, I think what I, yeah, like I'm worth more. And I think the, the typical mindset whenever you start is you're like, I need it low enough because I need people to join. I just need people to join. But I have found people are more intrigued whenever things are more expensive.

Cuz if it's too low, then they're like, Mmm. Mm-hmm. Are you like, are you a real doctor? And so, yeah, and I'm like, Girl, Yes. So, and there is like, there is some marketing thing that it's like you. Buy or FOMO or something. So things are, are more expensive then people find it more though.

I like go through and I had some mom tell me that she had to pay $190 every time she saw her doctor. Oh yeah. That's like $300 almost some places. And, and I have patients who have in, incredible insurance. Yeah. Cadillac inference , who still choose membership because the thyroid test needs to be done, let's say every three months or something until, and of course if they get pregnant and stuff.

More, more monitoring. Yeah. And they would rather not spend $300, $300 on a tele appointment for the lab test to be ordered. I do think that's like one of the biggest differences between myself and, and adult docs. Uninsured is the abnormal for me. Kids are insured. Kids always have kids, almost always have insurance.

So admit, and maybe that's Medicaid. But kids qualify for, for coverage, right? So I think I only have like 10 or less that are uninsured because they have health sharing. So all of my patients' families are like, Yeah, I just need, I need to talk to someone whenever my kid, whether it's a teenager with depression or a two year old with an illness and they're like, I just need to talk to my doctor.

So they realize the value. Yeah.

And I think that that Especially in our communities, especially for people who have, are opening where DPC is not, a very common thing. Like you go to a neighborhood in Colorado and you might have multiple DPCs to choose from versus, somewhere else where there's few no matter where we are.

The, the culture is, is definitely changing in that like you guys have shared, the, the growth that you guys have experienced because people understand what you're bringing to the table and how it is absolutely different than a concierge practice in terms of we bill insurance and the annual fee and it's very different from the fee for service practice that we were so ingrained to function in when we went to residency.

So, on that note, I wanna ask about what the future holds. So in terms of going into this next year how have you guys set goals? What are those goals and what are the benchmarks that you're using to achieve those goals?

So we are trying to figure out now that, the practices has grown significantly where exactly is this going to lead?

Are we going to see more and more patients and and just keep growing as a mom and pop shop? Are we thinking about adding on more of a physician team and more people coming in and doing like a multispecialty thing or just all primary care? We're trying to figure all of that out right now.

What I can tell you is that the guidepost that we're using is. How we feel about the day. And so we kind of take, at the end of each day say, Okay, this day was great, this x, y, and Z happened. And then I review that every couple of months or so to really just do a pulse check and make sure that just because we're on the road to growth doesn't mean we need to continue this way.

Each person could have like their own little micropractice and be, super happy and everything's, just fine there. So I can tell you that in terms of our goals right now, I know Christina is looking to have a smaller patient panel. Right now we're still thinking about family stuff and being there for those really critical times.

And that may change as, as children grow up and, and that kind of thing. But we wanted the freedom to be able to make that decision and make sure that we're still taking the best care of our patients. And so that's when we kind of always have a pulse on that. Are we, like, where are we in terms of how we feel, where are we in terms of how the practice is going?

And then ultimately, I have a feeling what is gonna happen in the coming months to coming year. What we're looking to do is add on either a pediatrician or a geriatrician to help help the practice grow. But each person, is still taking care of their, small little panel, their small little corner of our community.

And and I'm very curious to see where that goes. Still an idea we're, we're putting up in the air right now.

So I think in terms of goals there's been, there's been a lot of extra room in the past year for me to like, explore my personal situation because you see, you go through your residency and all this training like rapid fire and you have no time for family. You're just literally just eating, working, eating, working, maybe sleeping and then eating, working.

And so for the past year, first year of starting my Happy Doctor, obviously I was busy with like, just setting up and like learning how to even run a business and how to in, interact with patients, how to maintain that. My Happy Doctor role where, like Jake said, hospitality, I mean, I think I want patients to feel like they're at Disneyland with my Happy Doctor.

So if, if that was taking also a lot of my time, which is what it did, which is what actually happened this year, has been a little more extra time, just like spending time with family, figuring out what's next for family and me, and, all of those things. And I feel like extra time that I got was not necessarily.

Still enough to make up for those many years of, putting life on a pause for training. So I think what I see myself doing is obviously I will continue to find my happy place where I'm still, balancing out work with life. And I'm gonna start new hobbies like pottery. I wanna work with my hands and do some pottery and also want to learn digital art.

So I'm all interested about like, the lighting that comes in, all those pictures with cartoons in them. Like how do you get lighting on cartoons? Like, that's incredible to me. So I'm j I'm, I have all these courses that I have planned for. So there's so much more personal growth that I foresee happening in the, in the future, which I know is not necessarily what my happy doctors.

Professional growth might be, but that's gonna make me a better person. That's gonna make me help my patients who are anxious, feel less overwhelmed because I'm having the extra time to focus on my own wellbeing which is often underestimated. They, they expect doctors to be like robots, right? Most of the healthcare system literally just chop, chop, chop, chop, chop, and, and, and nobody actually cares to live the, the simple life anymore.

Doctors want to live the simple life, I guess, but this just don't have the opportunity. I wish DPC becomes predominant. That's what I want to see. Even though it's not my goal for my Happy Doctor, I, that's eventually going to be the goal for, of my existence, so to say, right? Like, I want there to be many, many more my happy doctors, even though the micropractice is my goal with, my practice.

I'm pretty much. Really happy with what I've achieved here, but there's so much more to do. So that medical students and, residents internationally even have, have an opportunity to think about this type of model because we see all the, all these successes. We, we are just hearing from just j only three doctors today, and it's been incredible.

Right, Right. Just two years of practice and we, we are seeing so much impact in the community. I, I really, really, really hope. I mean, that's my goal, whether it's for one year or for like a 70 years, I don't care if it takes that long to put the word out that corporate large, scalable, Income generating middlemen filled communities.

They really have to be replaced with the good or simple, straightforward, but high tech and really high quality healthcare from the ground up, like grassroots levels. So, so we don't ever have to say, Oh, I couldn't get an appointment with my doctor for three months, which is literally what we hear every day.

Yep. And it's so interesting for you to, to say that and also highlight, the, the impact that could be made even in international students, because like both of your parents are physicians in India. Yeah. And they, you've told me how amazed they are. They're like, why, why? How did we end up practicing the way we did for years?

And our daughter is thriving, practicing where she can focus on, I wanna learn pottering next year. That's

amazing. Yeah, I think dpc, I'm really, really grateful that I stumbled upon dpc. And one thing that I, I mean, one, you know how social media is, it can have its pros and cons and like huge impact in, in both positive and negative ways.

But I think no matter how much I want to believe that DPC just fell in my lap. It didn't , there was a huge, huge, huge role of social media cuz we are literally all over the place. I have never met you Maryelle, but all this wouldn't have been possible Right. If we hadn't, if we hadn't found a, a platform to be communicating with each other.

Absolutely. And Lauren, how about you in terms of what the, the next year holds? What are your goals and what are your benchmarks to achieve at those goals?

My goal would be to find another pediatrician. That's my big goal. Because I'm now, I've, I've been in survival mode for so long of just like, I need to, I need to get this up and running.

I need, okay, now I need to, now I'm profitable. Okay, now I need to actually make a salary. Okay. Like now I need to find, So I've just been in like the day to day that I finally, my husband was like, What's your five year plan? Like, what's your 10 year plan? Like? You need to be thinking longevity. And he was like, Do you wanna do this every day?

Like, if you do, great, stop. But if you don't, like, you gotta fit. You need to start figuring this out. What do you want this to look like? And so my big goal for this next year is to like, come up with a long term plan. Like what is, how do I want to be practicing when I'm 50? I need, I need to be thinking about that.

And So finding another pediatrician that will do this, which I am, I would rather wait forever for the right doctor, cuz I want someone who practices similar to me. I want someone, I want there to always be a consistent message coming from my practice. I want there to not be someone that is not like I have, I've been growing in like my LGBTQ kids and like, and my, I need someone that is like trans-affirming and doesn't think that it's weird or whatever I need, I need people that are like on, on the same page as me.

And so I will wait and as long as that takes to find that person. But my goal would be to find them in a few months because I also don't wanna lose, lose the momentum that I have with this practice and the amount of interest I have. And I'm finally getting around to like be popular enough and like, and trustworthy enough with other physicians that like obs are recommending patients to me and, and Family Doc are recommending patients to me.

And so the fact that I can, I have this momentum build up and this brand built up that I have to maintain it, but I also don't wanna lose that. So I wanna find someone quickly. And the other thing I have to do in the next year is figure out what I wanna do location wise. If I want to stay in this location, if I wanna move closer to my home.

And just for for context there, how far is your location from your home and what are the ideal things that you would like to see if you were to move to a different

location? Oh, so I'm 15 minutes from my house, which is not bad, but when you have kids, it to run, see a patient, it takes an hour and your house can get destroyed in an hour.

So it just makes it. Hard to, to run and do things because I'm like, Oh God. Like it's gonna actually take a significant amount of time. So I would like to be closer to my house. As far as location, so I have therapists that share the, I have two exam rooms built and I have two therapists that share my second room, which I love, and I don't wanna not have that.

But I'll have to build out another one. So then I, but like, so I, that's what I also need to figure out is like, what exactly do I want, but like, my rent to be cheaper, because right now it's like 50 grand a year. And so I would like cheaper rent, but that is just not gonna be possible because we live in a very, like, I mean, we live in Kansas City, like we live in the metro.

It's just, it's gonna be expensive. But I would wanna find something close, like, and then just things I hadn't thought about, like, I need good parking, I need stroller accessibility. I need. Like all these different things that I had never thought about before. So yeah, it's just things that like, I, I've also realized like how important it is. Like I have great work neighbors, they're so wonderful. They'll text me and be like, Oh, you got this package. It looks pretty important. And like, send me pictures.

They're just, Oh, they're so great. And so I don't, I don't wanna live next to like, or not live. I don't wanna work next to like a turd.

So, I don't know.

Spoken like

a true pediatrician. It's just like saying the word potty instead of toilet or restroom. And people,

someone, they have booger energy, G .

You all have been mentors for medical students, residents, other physicians, what closing words would you like to part with for this year's interview in terms of advice or things to look out for in the future?

I would say that advice wise, there are a couple things that I frequently tell 30 year medical students who come rotate who are thinking about family medicine, but they don't know if they wanna really dive into it. The advice typically revolves around don't try to look for the specialty.

Figure out people who are doing the thing that you like to do and then ask them how they got where they are, because medical students are starting to see, Oh, this is what life feels like for somebody who's in a DPC practice. And they say, I can do that.

And so the, the whole climate of what healthcare is gonna look like to your point, deep t. Is, it's gonna be something that happens, I think one third year or fourth year medical student at a time. Yeah. Once they can see what it means to give the kind of care that, that we as a community are trying to provide.

Once they can see how that fits into their own lives, once they can see what it looks like for someone else to practice that a light turns on and they say, You know what? I can do this.

I think mine is similar to that, but in reverse, like I'm always like, Figure out what you don't like. You don't like surgery?

Don't like being sterile. Okay. Surgery's not for you, you don't like, because that was like, I think the most helpful thing for me is like, I hated chasing INRs and I was like, You know what? I don't wanna do adult. So like that, something like that. That I know. I know. It's so fun.

So I like figuring out what you don't like, like I didn't wanna do adult genitalia. All right. Urology's out podiatry, like at all that stuff. So you figure out what you don't like, which then will lead you to what you like. Or figure out like what your, my personality would not go well with an adult, with adult medicine.

Like just straight up would not, would not be successful. So figuring out what kind of person you are too, that it's like, are you a shy and reserved human being that doesn't like having conversations and maybe primary care isn't what you need to do, but are you this outgoing? You love to talk to people, you love to be engaged and figuring things out.

Well, like radiology probably isn't for you. So it's figuring out, one, what your values are and what your personality type is, and then what you don't like, and then you can start figuring. Once you know what specialty you do enjoy cuz you've ruled out the other ones, then you can start like sussing out.

What do you enjoy about that specific practice? Do you like the academia part? Do you like the research part? Okay. Then maybe you need to go into the big hospitals and go into academia. Do you like what is it that you want and what do you value? And then you find something that matches that because they think so many of us like think that we have to change what we are to mold into a specialty versus you can find any type of specialty or whatever that, that you brings you joy and brings you light or what, whatever, and then make it match to you.

Yeah, I think, I think Lauren, you just nailed it. Like this aspect of finding the specialty and then this aspect of what kind of setting you wanna work in, academia, research, all those things. And, and the only thing I wanna add is these things evolve with time and you may just explore new things. And I started off thinking I wanna be a surgeon now look, I wanna do pottery, right?

Like it's, you wanna do something with your hands, maybe you decide not to do surgery down the road sometime. And then you also kind of explore the various, especially during residency, there's so many different options and opportunities. But I feel like at second year it helped that I nailed the part where I wanted to at least decide if I.

Want to do outpatient or inpatient or icu, or specialized further, or, specialized further in outpatient or specialized further as a hospital, focused or critical care focused doctor. The reason or procedural the reason being you can choose a bunch of elective rotations that are focused on what you like and enjoy.

Like I did a bunch of ortho sleep medicine, endocrine rheumatology, cuz I knew I was focused on outpatient. And that's pretty much the bulk of your, of the care you provide. Cardiology endocrine is, is, literally what you end up doing. So it helps. To at least, through medical school and all of that, obviously you have your dreams and just like Lauren said, you wanna weed out stuff you don't enjoy doing.

And then, like Jake said, you wanna focus on what you enjoy doing. And then, kind of build on top of it by just seeing a successful person who's happy in their life doing, whatever they're doing. And then get back to basically go back down their, their path of how they achieved it and what steps they took.

But the evolution, I'm not kidding you. Things I know, I know people who have already worked for, as, as faculty or already worked at private practice for eight years and are still figuring out what they like and what they enjoy. So it's never too late. It's like, you can start when you are, when you're 60.

You can be like, ah, I wanna do this right. It doesn't matter. It's, it's all about that present moment where you, whatever you feel is completely valid and you should just follow, follow doing, your. . Something I will add that to the residents is that something that I did that I'm so glad I did was I took a ton of specialty electives.

I didn't do a bunch of primary care electives. I did primary care in my continuity clinic. I did, I knew how to do primary care, so I chose specifically electives that I was bad at. I did a lot of renal, I did a lot of, of cardiology or whatever. And so then when I was with them, I'd be like, Okay, what are you comfortable with a primary care doc managing?

What annoys you as a referral? What do you think is an essential referral? And then I would go through and I, like, I kept a Word doc or a Google doc of like, Okay, these are the things that I can do on this. And I, in neurology, I was like, I'm gonna be a solo pcp. I need to do a really good, I need to learn a really good neurology exam.

So it's putting your own pride of. Oh, I can do a neuro exam, but like, no. I wanted to learn from the best neurologist in the state. What is your neurology exam? And teach it to me. And when I, and when I was in cardiology, I was like, I need you to grill me on EKGs and, and heart sounds like I need, I have to know these things because it's just going to be me.

And I think I am really glad I did that. And I also got a ton of cell phone numbers, so I have specialists that I'm like, da, da, da da. Like I won today. I'm like, Hey, I have an unended testicle in a one year old. You want me to get an ultrasound before I send him over? And he is like, Yeah, get 'em in next week so I can just have this level of care.

So get phone numbers, residents, but also like, don't do electives that you're good at. Do the one you're not good at. Yeah. Yeah. Which is part of like the specialty you choose or whatever you end up. Yeah. Yeah. If you're gonna do DPC primary care. Yeah. Yeah. That's what I mean. Exactly, exactly. . You don't have to do the stuff you hate , but what, what you, what you find a little bit hard cuz there's a clear distinction between those.

Yes. On those two. Yeah. That's awesome.

And just to add to that, one of the things that we did while we had some like management of family office elective time, I don't know if we ever mentioned this, was we would spend some time in the phlebotomy clinic. And so we would learn a couple of those like accessory skills because hey, if we're going solo, it might be a good idea to have that on board.

And so, thi little things like that can be really helpful when bringing your practice together because all of a sudden it decreases the barrier that you have to surmount in order to provide full scale services.

Yeah. I did that with our nurses. I became good friends with them and I was like, teach me to place an iv.

And I just would spend my night sitting and placing IVs in them. And then in the ER I'd be like, Hey, anytime I need, I order labs, will you let me draw? In my continuity clinic, I started giving my patients their vaccine so I could learn cuz I knew I was going to have to do these things. And I, Yeah, doing those accessory things that you don't think about because they just happen is important.

So again guys, it has been such a pleasure. Thank you so much for joining us today and sharing this last year of your guys' practices.

Always, always happy to, join this awesome team and chat about stuff.

*Transcript generated by AI so please forgive errors.

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