Direct Primary Care Doctor
From Dr. Pritchard:
I’m Dr. Jlyn Pritchard – a Mom to 3 wild humans, wife to Jon, & Family Physician in Spokane, WA, practicing Integrative Family & Obesity Medicine. I dreamed of being a doctor when I was a kid & was inspired by my step-father’s dedication to the ER as a physician.
I attended Gonzaga University, then moved to West Virginia to attend the West Virginia School of Osteopathic Medicine. During that time, my now-husband Jon served in the Army at Ft. Bragg. We lived in separate states (and countries, during his deployment) for the duration of medical school, finally moving in together over 3 years after we got married.
Residency was here in Spokane at a great community-based program that provided true full spectrum & rural training. I quickly found, however, that the landscape change that occurred in healthcare during my time in training meant that the life & practice I had envisioned for myself wasn’t exactly possible.
I made a commitment to myself my senior year of college that I would never lose my “art”. I wrote poetry in high school. In College, I ran a solo photography company in my spare time – a journey that continued through medical school & into residency. I discovered writing was cathartic for me during residency, helping me process all my experiences. It felt like ever-so-slowly, my creativity was being drained as I practiced medicine; or perhaps smothered by other things deemed more important.
Finding the possibility of DPC has restored some of that creativity. Restoration is going to look different for everyone. For me, right now it looks different than it did 5 years ago. And maybe that’s the beauty in all of this: evolution. DPC as a movement has seen the need in healthcare & stepped in to meet them; as an individual I’ve seen the gaps in my own life & made intentional changes to remedy them.
Thread Health just opened in October 2022. I’m a novice when it comes to experience here. But DPC has allowed me to find little bits of myself again, to lean into my values, & the inception of Thread has been the scariest, most satisfying decision in my career.
CONTACT/SOCIAL HANDLES:
Facebook: Jlyn Pritchard
Instagram: mamamedicinedropper, Thread Health
TikTok: JlynPritchard
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Transcript*
Well, Welcome to the podcast, Dr. Pritchard.
Thanks, Maryelle. It's great to be here.
So for the listeners Dr. Pritchard and I are recording under unusual circumstances called the Fall Season and Kids Getting Colds. And so my voice is definitely noticeably different. But it is such a pleasure to talk with you live time and for you to share your story because you've been so active in regards to the podcast, the attending, the fireside chats that we've had and just really you are a prime example of how a person can really harness the resources out there and reflect on those resources in terms of how those resources can actually help a person achieve their goals.
So again, it's super exciting to
talk with you. Thanks. I'm of fangirling right now too
love it. Love it. So, I wanna start just by asking how did you even find out about the podcast? Because that's how I feel like you and I really connected in terms of when you have been involved in the fireside chats and whatnot.
Yeah, I have a good friend from residency, DRN Baker. He owns Baker dpc. That's about 45 minutes away from me. And when I was in a life transition, which I think we'll probably get to later he and I chatted, We connect, we reconnected for the first time since residency, and he invited me to the DPC Docs Facebook group, which has been incredibly instrumental in my journey to this place.
I feel that illustration of one generation standing on the shoulders of another generation, I don't know if you are visualizing what I'm saying but there's a artist that interpreted it as, a little girl standing on the shoulders of her mom. Or you could extrapolate that to any situation.
And I honestly feel like that is the DPC Docs Facebook group. All of these forerunners that have gone before us have really paved the way in incredible and diverse ways for us to show up. As our true selves and allow us to do this with some bit of ease. So Dr. Baker was the first one that introduced me to the Facebook group.
And then I'm a big podcast fan and so I listen to this every week when I'm on a walk with my dog on Sundays . So I've been a pretty devout fan since the very beginning, and I think it's an amazing thing that we get to hear people's stories and relate to them in, a myriad of.
And I love it because, and I thought of this when preparing for this interview.
This is a little time capsule for yourself in terms of, when you're talking to medical students, residents, future partners, you can reflect on, wow, like this is exactly what a person, is supposed to be experiencing. Or, That was really hard for me. How did I get through that? And so I think that is overall the value of these podcasts in terms of even if a person listens to themselves three years later, they still are able to reflect.
And so I absolutely love that. You and so many others tune in. And so let's get started with your story. Now in terms of your exposure to dpc, there was life pre dpc and then there was life preparing for dpc. Yeah. So can you give the audience a little bit of a flavor as what's as to what was going on in those two at times in your.
Yeah, so my story I think is maybe a little bit different than a lot of people who have gotten burned out with a corporate culture of medicine. I was in residency here in Spokane and it was a pretty comprehensive full spectrum family medicine residency. We had rural rotations and I felt incredibly prepared for practice.
When I left. I had a baby, our first baby halfway through residency and at the same time there was a transition, a corporate, merger happening. And I literally left for maternity leave, which is 12 weeks. And I came back for maternity leave. And it was in some ways, like a completely different program that I was walking into prior to me leaving.
There were two major hospitals in town and they were friends. We had rotations in both locations. It was a very cordial relationship. We had a huge amount of community involvement. It was a very low key, It's like the wild west out here. And so there wasn't a dress code and it was a very chill, laid back program.
And I returned for maternity leave and I had a dress code on my desk that said that I couldn't wear Shoes showing my legs without nylons. And there was so many changes that I was like, I don't like this. And I made the decision pretty immediately to intentionally avoid non-competes and corporate medicine.
And I became a little bit of a core value for me that I was like, I need to hang on to what I knew before. Just because I loved how laid back and authentic everyone prior to that merger had been present. And so when I left residency, I joined a physician owned practice, which it was the ideal scenario.
We were actually operated by a larger corporation. So we had benefits and pay from them, but the actual operations on the day to day clinic side were all physician owned, physician run, and physician dictated. It was an incredible practice that essentially was made up of these small, independent, I call 'em cowboy doctors.
They were the first generation they were delivering babies and doing appendectomies and like rounding in the hospital and their incredible individuals. And they realized, post aca that their individual practices couldn't survive. And so they merged together and created what I was hired by.
And that was amazing. We ended up moving for my husband's job back to my hometown, which is in south central Washington State. And in the process of that, I faced, a dilemma because there were not many opportunities. And I ended up joining a private practice. So completely private, no corporate entities, no non-compete.
And it was an incredible learning and growing experience for me. And also very eye opening to the true. Side of medicine that is fee for service, right? Like massive overhead. Very much the feeling that, I was seeing 24 to 36 people in a 10 hour shift and just burning out like I was awake until 2:00 AM every day that I was working.
And we had our second baby, and then our third baby. And so it just was not sustainable for me. I watched in the four little over four years that I was there, my partner's incredible physicians just wither away as far as their motivation goes. And while I was there for the first time in my career, had the opportunity to exercise a little creativity muscle.
Very much pre covid. I started telemedicine for the clinic. I started group prep, group visits for the clinic. And there was a great acceptance of those things and it really got my wheels turning about healthcare innovation and how can we meet people where they're at while trying to manage the challenges of this fee for service structure.
Fast forward a couple of years and we decided again to move back to Spokane. My husband's job that we had moved forward didn't turn out the way that we had hoped, and we really missed the mountains and the trees. And so I joined an advanced primary care startup that was a branch that was located here in Spokane.
And it was essentially , value-based care plus health coaching. Amazing structure, 30 to 60 minute office visits. And at the very beginning of my contract really was quite Like grassroots, I guess that's what I would call it. So we had a lot of flexibility, we had a lot of opportunity for innovation.
But very quickly it became apparent to me I was one of the lead physicians that probably things were not gonna stay that way for a very long time. So I actually, and in the midst of all of this, my very last contract was at the beginning of that contract, Dr. Baker, My friend, started his dpc.
And so I was able, from a first hand seat to watch him grow and honestly thrive. He's doing phenomenally well. And then I, sit on the sideline and be like, Wait a second, I'm not, this is not enjoyable for me to be involved in this corporate structure. That company contract ended and it ended seven months sooner than I thought that it was going to end. And so I had the opportunity to sign on with a new company that was very much corporate medicine. There was no non-compete, but it was another kind of startup that had, had its site set on something that did not align with my own personal values.
And I took the leap, like , there was really not another option for me that helped me live into what I'd promised myself so many years ago. And so I literally opened my doors last week. , I'm a newbie here. But that all of that I think led me to really having this kind of broad perspective on there is not a better way to practice.
And there, despite what you may be promised by a corporation I really don't necessarily think that they have your best interest in mind. And I think until we the hashtag take back medicine like, I really think until we do that with a fire under our buns, I don't know that we're gonna see any big changes.
And so at some point, I think you have to make the decision like. Poop or get off the pot, like back away from the cliff or jump, like whatever analogy you'd like to use. But I think at some point you just have to do it. And so I did.
Awesome. Awesome. And again, just going back to how you've researched DPC and how to do dp, what kind of strategies would work for you and your clinic?
I wanna ask there there were some, sometimes during your journey into researching and planning DPC that. Agonizing to, make the decision to be the primary breadwinner of a family of five. To go into jumping off the cliff or, getting off the potty. Clearly that was a, that was a mom word right there.
Um, Yeah.
Right. . Yeah.
Uh, But, can you share what were some of those agonizing thoughts that you had and why did you have them? Because I'm sure there's others in the audience that are going to listen or are listening actively right now as you share your journey. Yeah.
I think I, I will say this, we had been very determined after residency graduation to pay off med school loans.
So we have lived incredibly frugally. Goodwill's my favorite store. We still have a really strict grocery budget. And so I really have very intentionally tried to not let the golden handcuffs affect us as a family. But I think there's a creep, right? That happens like I'm almost 10 years out of residency and there does reach a point where you're like, Gosh dang it, I wanna buy some raspberries in January.
And so I think that, first of all, getting med school loans paid off was absolutely a stepping stone that I don't know my personality if I could have taken the leap if I still had that hanging over our heads. And that being said, I think that we have made some super intentional decisions not knowing what the future would hold.
When I signed this last contract, I wasn't sure if it was going to be a forever thing. And I will be honest, if you're into Ingram, I'm an Ingram type five , which I think to my detriment, I can over contemplate and over perseverate and over research. I remember when we were having our first kid I, I'm embarrassed to say this, but I honestly think I researched baby strollers for like six to nine hours.
No one needs to do that, and I did it. But I do think that on the flip side of that , that annoying personality trait makes me much more prepared in. Extrapolating all of these scenarios that could happen and going through them in my head. So I think, we first started talking about this and honestly, my husband was really not on board.
He and I would love at some point to get him on here because I think his journey in a spouse's journey or your partner's journey is just as important, especially because it's not lots of times, right? It's not just you, it's it. You're in this like tiny community, which is your family, and then this bigger community.
Trying to figure out how you fit in as a puzzle piece to all of those can be really difficult. In his defense, he did not come from a family of entrepreneurs. Both my dad and my stepdad were self-employed. He was in, he was an army brat when he was younger, so he had Tricare, which is great if you're healthy, right?
Like it's a great insurance that covers everything if you're healthy from a patient perspective. And so he really has not had many interactions aside from a couple of knee surgeries. He's not had many interactions with the healthcare system and not quite understanding like , you can't just call and talk to your doctor, like he's been able to do that because of my connections.
So it took a long time for him to come on board and in that time period Erica Awas, who owns Foothills DPC in Phoenix, has had been incredibly instrumental in this like internal journey that I went on trying to figure out. Where my priorities were and what my values were and how I was going to live those out last year, I think I reached a low point.
And all jokes aside, I was using my Peloton as Prozac. It really got to the point where I was like, I don't think that I'm myself anymore. And that's a scary place to be. I mean, I remember in med school when we were in our clinical skills class and learning about like the PHQ nine and the GAD seven and all of these screening tests, they intentionally said, Please don't take this test because most of you'll score positive.
And that's a tough conversation for a different day about what medical education does to people. But I was in that spot again. I had postpartum depression after our first kid, had no idea that I had it until 10 months when this like fog cleared. And I was like, Oh my gosh. , I myself again. And I could feel myself slipping back into this place where, I have TMJ and I was grinding my teeth every night.
I had chronic neck pain. I couldn't sleep. And we didn't color Easter eggs this year, which seems like such a dumb, ridiculous thing. But I had completely lost track of time. I'd lost track of where my priorities lied and my kids were getting the worst of me. My spouse was getting the worst of me.
And Erica was really instrumental in really asking me really hard questions. And challenging me to say Okay, Jalen, if autonomy is your core value and it is, how are you going to lean into that if you have no control? And I finally did reach a point where I said, Forget it. Like I have to jump, I have to make this jump because it's the only thing that's going to save me as a human, right?
Like to maintain my humanity. And I think the other thing that, as part of this journey of discovering what my values were, I also discovered that I was grieving. This podcast got real deep all of a sudden. But I was grieving because I was part of that generation of physicians that saw pre governmental.
Regulations, Is that how we'd like to phrase it? And I had mentors as a kid and as a high schooler, and even as a college student that were practicing in this pre regulatory world. And they were, it was hard. It's hard. But they were thriving. And then I, on the flip side, graduated from residency in this post regulatory world that it did not cause anyone to thrive.
And looking around those same mentors quit medicine because they were at retirement age. Very quickly after that, those regulations came into play. But as a fresh grad, you don't have the opportunity to be like, It's time for me to retire. And just seeing them and seeing the exodus, I think that people made from medicine.
This is the solution and it's not the solution globally, but it was the solution for me in realizing that hey, you still can have autonomy. It's going to be hard, but it's going to be hard anyways. And so I think that for all of those people that are just starting, I think you have to take a good look at your finances and you have to start making intentional decisions early.
We did not buy new cars. We did not buy new houses. , we still budget for our groceries and occasionally when we have extra budget, extra money in our budget, I will buy raspberries in January. And then I think the second step is really deciding what your core values are. Because if you cannot if you can't recount those core values I think there's probably still work to do before you jump in headfirst to this.
It understanding and aligning my clinic with my core values has also allowed me, again, to show up authentically as myself without the feeling that I have to wear a white coat. I've never worn a white coat or without the feeling that I have to pretend like I'm someone else and not, crack jokes or be sarcastic with my older patients who love it.
They love the sarcasm. Um, So I, I think that would be my biggest piece of like wisdom nugget that you have to understand who you are and what your values are. And Erica may be mad at me, but she does great coaching. Like she does an incredible job coaching people through what those values are because sometimes they're hard to uncover amidst all of the other stuff that we have to deal.
And I think it, helps also that she can relate to you on many levels professionally. Yeah. As well as personally. I think that's, one of the things I go back to is Dr. Kristen Ray Coleman had shared, you know, when you choose somebody to help , do things like coaching she said the comment, Make sure you see their receipts.
And so I think since she said that, it's been something that I've mentioned to many people be because, when we're, when we are in a spot where we don't necessarily have the bird's eye view of all the possibilities and the pros and cons that can happen depending on which, which branch we choose of our future.
It can be even more stressful I feel sometimes. So I think that's wonderful. That you guys connected and that she helped you so much. . . Mm-hmm. . So now that you are in this spot of, you've been open, Yes. You have just opened recently, but you are open, you are going into your space. You just posted how you and your family went roller skating for the first time for yourself since eighth grade.
It it's so exciting. Like, I, I get that people in fee for service can do those things too. But in terms of when you said, this is my future. I'm going to make, this is my next step. Can you describe how your thought processes and how your approach to problems or challenges changed?
Yeah, I, it's so interesting. I have been reading, which again, my personality, it's almost a fault. I think I have read through every archive, like back to 20, whatever, 16 when the DPC docs board was initiated. But I think that, somebody said at one point that it's still the same amount of work and it's still the same amount of hard.
So choose your hard, but something is different about when it's your own thing. And I feel like I definitely, I mean, I signed my lease in June and I have a hilariously old fashioned landlord. He will never listen to this podcast. He does not own his cell phone. He's a fantastic guy. My bathroom flooded and leaked into the storage room at the office next door.
The flooring was delayed by three weeks. We were stuck in supply chain purgatory. The toilets that we got didn't fit and we had to call a plumber to saw. I, I mean, you know, Like the list is just like, but I'm like, I don't care. This is happening. And I think that the days. When I get to dictate my schedule, again, aligning with my core value of autonomy, when I get to dictate my schedule, which is honestly intimidating still.
But when I can say, Sure, I can run to the post office for you, or I can go to the mailbox and pick up that package, or sure, I can be at school and drop the kids lunches off that they forgot three times last week. True story. It allows me to step into a role that I've never had the privilege of being in before.
And it allows me to really lean into motherhood in the ways that I wanted to. That's why I chose family medicine. It's why I didn't do eent or neurology or something else that would require my time away from the kids more. And family medicine was supposed to allow me more flexibility, which in many ways it did.
I've always worked part-time. I've never worked full-time since residency. And that again, was an intentional choice, but I was seeing little dabs of my flexibility and autonomy be taken So I think the challenges are there. They will always be there. And I don't have this rosy glass's view of what DPC is probably, again, because of all the research and reading that I do.
But I do think that it hopefully will allow me , to fulfill both of the roles that I'm in, right? As a mom and spouse and as a physician more completely. Instead of feeling like I am literally in the splits all the time and trying to decide which way I'm gonna go.
Because I think that's the position, especially as women that we get stuck in most of the time without the strings of autonomy that we should be given in the workplace. This is across all workplaces, right? Not just physicians but that we're not.
Absolutely. And in terms of, then you throw the pandemic on it and that was amazing.
Especially as a mom, and mom can be single dad, single parents or whoever. Yeah. But, But the idea that, you know, Your journey with, respecting autonomy impacts your entire life. I think that's a really good thing to focus on. Because when I think about how, you had this experience in residency, you had your first kidney, you came back to a completely different residency when I think to, the do eyed medical student applicants writing their essays, and we were those kids too.
Even though, like for example, I went to Creighton, we had, humanism and medicine, but it was like, what was the actual discussion about humanism and medicine, What your values are, your autonomy as an individual and how do you protect that into the future? You know that, around that idea of autonomy.
I'm just wondering in terms of your thoughts, how do you challenge, because again when I think about this podcast, I think about this is a great way for medical students and residents to really hear, people reflecting on their journeys of autonomy and loss of autonomy in many cases,
But how do you challenge medical students, residents, physicians, and fee for service to think about, their own autonomy when they're asking questions specifically in the world of dpc.
Yeah, I think it's a, it's an interesting point and I'll share this story. I was sitting around a dinner table, so I was one of the lead physicians here with the company , that I just left.
And there was a small group of us at dinner and there was a really long time in the past year prior to me, making this decision. And even like until yesterday , that you have this what's wrong with me feeling, right? You have this, like why is, why am I looking on the other side of this one way mirror?
And looking at all of these physicians that are employed and they're, they seem on the outside to be fine, right? They seem to be fine and there's this self reflection that's like, what is wrong with me? Why can't. Be happy. Why can't I just settle in the role that I was put in? And there was a lot of pillow talk between my husband and I about him saying, Why can't you just be happy?
I think you've never been happy in your career. And he's not wrong. Like he is not wrong. But I did realize that really played into some of the grieving that I was feeling, that pre, regulatory and post regulatory life that I had envisioned for myself. And it was this process of letting that go.
Letting go what I thought was going to be. You know what my practice as a physician would look like and realizing that number one, not all physicians have the same set of values. There are people that do value money more than their autonomy. There are people that value academia and, research more than they value their autonomy.
And there's nothing that says that you have to be a one size fits all. For me, my autonomy reigns supreme. That is the one thing that if I lose there is never a job that I can be happy with. There are certainly others and I have good friends that value money as their number one, motivator.
And if they lose that, then they will never be happy. Autonomy comes second, third or fourth. So I think to the people that are, especially those in training I think that they need to find a mentor and they need to ask some really hard questions. A lot of those classes that we were exposed to in med school and residency about humanism and ethics and corporate culture, It was always us versus the patient, right?
It that's the stance that we took is it was always how do you interact with a difficult patient or how do you interact with this ethical situation with a patient? Unfortunately, that lens was never turned and we never learned about how do you interact as a physician with a corporation, and that's really where the conversation needs to be.
that's where the conversation has to go in order for us to actually have enough bandwidth to reflect as a med student, as a resident, as a new attending, as a seasoned attending, and say, Wait a second, where do I fit into this puzzle? Because I am the person that I want to be as a physician. I have protected that with everything.
But unfortunately for many of us, it's been at the sacrifice of other things. And it feels a little bit you know, like a tick. Like you're just, it's just sucking away. And so I think finding a mentor and being able to have the freedom to ask those really hard questions about how their life looks on a daily basis.
I think in training, understanding the background, the ugly side of corporations, there are beautiful sides of corporations too, and I don't want to talk down all of the physicians that are still employed or who enjoy employment. A good friend is in New York and he's in sports medicine.
He loves his job and I love that he loves his job. So I think that just understanding, the business landscape and how you fit into that is the very first step as a resident looking for jobs. And then, I would say third is your values will change. They're going to change over time and that is totally normal and that is needed in order for us to adapt.
But I think that you being aware of them, which I was not, right? Like I, I didn't, I hadn't taken the time to be like, Oh, that's the one thing that's driving you. But man, how far ahead would we be, have been, or would we be if we would've been able to take a step back and say, No, I'm not going to make that decision.
I'm not gonna make that move. I'm not gonna accept that contract. I won't take that bonus because it doesn't align with my values. And I think that, I love this generation that's coming up just because of, there's so many things I think that my generation is looking back going, Oh, that was a really bad idea.
That, that was a really terrible decision that we made. And that the generation that comes after us, both in medicine and culturally is going, Hey, you guys made some real bad decisions. We're not gonna repeat that. I would love for there to be, some sort of non-biased mentorship program.
And I think there's a couple of them that are out there. But I just think it's so important to be connected to people that you feel like you can relate to and to ask super hard questions and have the freedom to feel like that, that you can change, that everything's a stage, and that you can change through those stages.
I think that it's taken me at least two to three years to not be embarrassed about how many times I've changed jobs, right? Like I think we have this attitude, and again, this is coming from this pre regulatory, early two thousands attitude of I opened a practice and I stayed in it for 35 years.
And that's just not reality anymore. People do jump jobs. I have a hand, small handful of friends from residency who are in the same practice, in the same job and, feel like they're satisfied. But I also have to realize they're individuals and they may not have the same value alignment that I do.
And Again, being gentle with yourself and saying You know what? I have had these jobs, many of other than me leaving private practice, they were not my choices. Like the contract ended with my first job and it was taken over by an hmo. No thanks. I left my second job because of family circumstances.
My contract ended again, and, it's not something that I chose. And I, I think just allowing ourselves to not hold this expectation that is unrealistic in the current healthcare landscape that we're in is equally important to everything that I just said.
So well spoken. And one of the things I think about is and this is for me, it came from Lauren Tan Creedy over at Hint.
She had shared with me when I was talking with her about DPC in general. The what's your one, three and five year plan? And I think that is really something that no matter what stage you are, especially in medicine, in training, whether you are, new attending or a seasoned, you can always reflect on.
What is my one, three and five year plan, and am I on that? And as those values change, absolutely. Being able to have a tribe where you can reflect and grasp questions and feel safe. I think that dpc the community itself really does a great job at providing each other with avenues of support in that sense.
So definitely as you mentioned before Facebook groups, there's there's there's actual professional coaches like Erika Wattis. There's there's mentorship programs through, informal ways, formal ways, but there's definitely ways to protect your autonomy in terms of being able to reflect on yourself even in this professional community.
So I love. Now when you when you know we've talked about how you came to this decision. You jumped off the cliff, you made this decision to open and you've opened now one of the things I remember was that you had shared that practices that were doing DPC in the Spokane area had closed and so I wanna ask, in terms of your thoughts, potentially fears as to who would join your practice going from that space to people are definitely interested in your practice? Yeah. Can you give us an update as to who is interested in your practice and who has joined?
Yes. Oh my gosh. So this was so hard for me because I feel like. When you're like dreaming about this thing that you think is gonna work, and then all of a sudden someone like drops a rotten egg on it is Oh, sorry, there's other people that have already failed. I'm like, What? This is just not, you just don't hear about people that close their practices from failure, right?
They move, they decide to retire, they sell the practice, et cetera. So there was two practices here. And in hindsight I did not know at the time, and I have found out since that they were not true pure direct primary care practices. So they were hybrids, they were taking insurance or the patients could opt for, a membership, an annual or monthly membership.
And I went I mean I really got myself into this like spinning tizzy about how do you build a practice in a community that already has seen something and rejected it. I will say Spokane. Is interesting demographically. And my husband and I sat down, my husband has his mba, and we sat down and did a little market analysis.
So we looked up, like Washington State healthcare exchange. We looked at population demographics, we looked at income range. All of those things, which I think really helped me in the mindset that I was in because of these failed practices to say, Okay, this is where we need to start from, and this is who our target market is.
And by the way, if I was ever reincarnated, I would not do medicine and I would do marketing. I love marketing. But we took a step back and we said, Okay, how can we prevent this from happening? But it did not help me from spinning. I definitely felt like I was walking into something that somebody had already abandoned and said, This doesn't work.
Because of Spokane's demographics. We live a little bit north of Spokane and 15 miles beyond where we live, it opens up in, is rural, like completely rural. And then south of where we live, about 11 miles south of where we live, it's a much more densely populated area. And there's like little pockets of higher socioeconomic status scattered with very low low income individuals and families.
We have an amazing fq HC here. But we have Get Ready. We have one single concierge medicine practice that is 20 miles north of me. That is it. There is no other concierge practices. And when I started doing this market analysis, I realized that we had. Naturopaths in town that we're charging hundreds of dollars for one consult for hormone replacement therapy, testosterone supplementation other various potions and tinctures, or promises that they tend to buy into.
There are a couple great programs here and I don't wanna d dis all of the naturopaths. But people were paying for them. My patients were coming in saying, I saw Soandso and I paid blah, blah, this much money. And I said, Wait a second. The money is here. Like people are will be willing to pay for it.
We just have to structure it so that it actually sells. There is a nurse practitioner here who has been in practice for five years, I think, and is doing really well. He's a super nice guy. And then dr. Baker, Drs. Liberty Lake also had started his practice and has just done phenomenally well. Slow growth, steady growth, but done really well in general.
And the reassurance from those circumstances, gave me a little bit of oomph to start. And I decided, you said one, three and five years, I take my life in two year increments. Like we signed a two year lease. I said, I'm gonna give this two years. And if I don't grow to where my goal numbers are at those increments, then I turn around and I get a job.
Is it the end of the world? It will be at the time, it will be devastating. But we're gonna take things in two year increments. And I think that as the. Healthcare landscape starts to change. Washington's one of 14 states this year that's supposed to see a rise in premium somewhere between 10 and 28%.
Post covid. And I think that a lot of what the beauty in direct primary care is that you have to know your own landscape. You have to know your own community and your own landscape in order to show up for it. When we did calculations, it would've been, oh my gosh I'm gonna get this number wrong, but as a family of four, so two adults and two children in Spokane to get health insurance off of the healthcare, Washington State Healthcare Exchange, I think was $1,800 a month just as the premium.
And then it was a three to $5,000 deductible. Understanding where your market is, and I think there's lots of people that don't, that. Believe in market analysis. They're like, Oh, people, build it in. They will come. That is not my personality if you haven't figured that out yet.
And so I needed something to dig my claws into, to say, I know that people are here. I just have to figure out how to find them.
I love that how you said, know your own landscape in your community as much as you can do, do the research that makes you feel comfortable to potentially open in, in dpc.
But going into knowing your landscape in your community, what were the value propositions of your clinic that you wanted to bring when you.
Yeah I actually struggled with this a lot because for our family, we have insurance through my husband's employer. It's terrible insurance. It's, our last year, which they changed the total out-of-pocket cost.
But we are in an incredibly high deductible plan. And, we've had a hand, a small handful of circumstances where we have not, we, it's. $500 away from meeting our deductible. And imagining that we would have to spend that on an annual basis is just absurd. So I knew that financially there was going to be a lot of value for consistency and cost.
And from my budgeting mind, right? Like again, we are like strong Dave Ramsey. Like we budget every month like . From my budgeting mind, I knew that the consistency and cost was gonna attract a lot of people. However, there are many people that I have encountered in the last handful of years here that have amazing insurance.
They're incredibly blessed with their insurance, but they can't get an appointment. I mean, I think somebody messaged me on Facebook and said that they tried to get in to their the person that they'd been seeing for the last three years or so, and they were booked out till January. And I think that it's a whole.
Because we don't have concierge clinics here. It's a complete mindset shift for the public in understanding like, Hey, I can do that. Like I don't have to send you to dermatology for every skin biopsy. And no, you don't need to see ortho for every joint injection. And yes, I can put in your I u D. And it's this whole mindset shift.
I was really lucky in that I had so much time with my patients in the last job that I was in, and I think that it allowed my personality to shine through. And also it allowed us to actually have genuine conversations. Like I knew that, Nancy was gonna be in Italy for two months in October, and so I could follow up with her.
And I knew that Mark, had lost a kid during Covid, or I'm making up these names, obviously. But so that relationship I could see a little glimpse of what medicine was supposed to look like. And I think that combined with the market analysis and it was a DIY market analysis. We did not pay anyone to do it.
Really gave me the hope that this was actually, that this was doable. But I think that finances, is one motivator for people. And I think that accessibility is another motivator for people. And consistency is yet another motivator. And so I think in marketing for a direct primary care practice you can't throw out one hook and hope that every fish takes the bait because you're gonna be fishing for a really long time and you're gonna miss a huge amount of the population.
So when it comes to my marketing, I think we just have to consistently cover those things. And I. I think word of mouth spreads fairly quickly. I was lucky that I had a social media platform before I started the practice. Cuz I got a lot of, there's been r for so and so told me about you because they follow you on, Instagram or whatever.
So that did make it easier for me and I won't deny that.
That's awesome. And in terms of how you shared you've gotten the space and you have a great landlord. How does your space reflect your, what you're wanting to bring to the community?
Yeah, I wish that I could answer that question, Muriel, but we currently I think it's much like you, like I was just, we were debating this morning before the kids got up, like, how are we going to get this done with three kids?
They happen to get in the way a lot. My hope is that this space feels like home and I I'm really not one for, I always tell people that I'm an osteopath I'm a fan of chiropractors if they're the right chiropractor, and I, people are like, How do I know? And I'm like, You walk into their office and it's like 1945, , there's no fancy lasers or machines or anything.
And so I really wanted to keep things as simple as possible. But I had a friend help me with branding. She did a phenomenal job. She does this for a living. I keep convincing her that she needs to put a toe in the DPC group because they think she does just a fantastic job. And so I really wanted the space to be reflective of branding, but I wanted it to feel like home.
There was a patient that I had during Covid who was recommended. We have a mutual, so our kids go to a pediatrician who's a good friend of mine, and her kids go to the same pediatrician. And so I gave her my cell phone number which I did frequently in fee for service, just because I thought it was the right thing to do.
And she She called me one day on my cell phone and said, Hey, this was peak covid. Hey, I have a five month old and the office told me that I couldn't bring my baby to my appointment. I'm really sorry, but I think I'm gonna have to find another physician. And I called her back and I was like, Are you kidding me?
Who told you that? And I was like, You know what? Bring all four of your kids just to spite the office. And so there's been so many circumstances, you know that Covid has highlighted that our. That are unfortunate, I'm gonna use that word cuz I think it's the gentlest word. But I wanted my office to be a place where families could be and that they would feel comfortable being, and that it didn't feel like a doctor's office.
I don't wear a white coat. I wanted it to feel very homey and warm. So you'll, we'll, I'll post pictures and you can tell me whether or not it actually accomplishes that. But that was important to me because I think, the worst thing ever is going to a doctor's office and having your kids like licking the floor, not knowing what was on the, what was on those things before.
It's terrible, but. Yeah, so we're working on this space currently.
Awesome. I'm laughing over here because if for anyone who's rode Bart in the Bay Area a mom dropped to pacifier an accident just popped it back on onto the floor of the BART station and then popped it back into her GIS mail.
So that's a great goal. I was working at a Dyson vacuum the other day, so I love that goal. I can relate to it completely. No. In terms of building out your clinic and making it work for you to respect your autonomy, one of the biggest things that a person has to go through is choosing the tech to work for them.
Can you tell us give us a, an idea as to what were some of the guiding, factors for you when you chose your.
I've spent way too much mental energy on this. I'm not gonna lie to you. It was like agonizing to me. I, because of all of my jobs I have and I actually did moonlight in residency. But I've used seven EMRs. I think they were maybe up to eight now. But Hold on one sec.
I've used seven EMRs and it I knew what I wanted in an EMR and I knew the capacity and capabilities that I needed in order to function, and then I knew what I wanted as far as like bells and whistles. One of the mantras that I've tried to keep in mind through this whole process is like start with the end in mind.
So if you've ever read. What's that baby? The baby wise, The start as you wish to go on is like one of the mottos. I don't love baby wise by the way. We had children that never slept. So start as you wish to go on, Start with the end in mind. And so I had to envision myself with my max patient, pa, 3, 3 50, 400 patients.
And how was I going to communicate with them? How was I going to function on a day to day basis? What data did I want to be able to pull out of the EMRs? And there were a couple of them that were very rudimentary and I thought were incredibly innovative, but they did not work with my brain.
I hate popups. I don't want things popping up in my face. I want to be able to navigate the whole chart while it's in front of me. I want to be able to, like quickly search for patients based on diagnosis or Search for patients based on my interactions with them.
My last EMR that we used it didn't give you details like, like you couldn't edit the subject of the visit. So all it would show up is like office visit toe, and you're like, Okay, but what if I talked about 12? During that visit. So I needed something that was very flexible. I also do prescribe supplements.
I'm very conservative about them, but I do think that they have a role in some people's care plan. I do hormone replacement therapy. I am taking obesity medicine boards. I may delay the test till 2023, but right now I'm scheduled to take them in three weeks. So I needed something that was gonna flex with me and I finally landed on Serbo.
I've been very impressed with them. I feel this is gonna put shutters down some people's spines, but I feel like they're a baby epic. I feel like they kind of have the same functionality without all of the like black holes that Epic can leave you, lead you into And then Haley Miller introduced me to Text Expander, which I am doing locums right now.
And I was losing sleep over me trying to get my phrases back in Epic and get them in Serbo and Text Expander has been like the magic fairy godmother of the whole, cuz I can put them in both from one level.
Awesome. Yeah, and just for those people who might not be familiar with Tech Expander, you can use it on your phone, you can use it on your iPad you just download the app.
So yeah I also am a user of Tech Expander and I love it. Now in terms of communicating with your patients , are you portal or no portal? Clearly you have Serbo, but that doesn't necessarily mean you have to use a portal. Because I wanna hear your stance on that because some EMRs that are targeted for D P C users have portals and others don't.
So what was your thought process? Yeah. When it comes to planning from the end
backwards. Yeah, that's a great question. So what I I honestly tried to take the things that drove me crazy about my last practice structures and fix them. So I decided to use Spruce immediately. I thought that they were, it was a great concept.
We actually had a texting line in private practice and people loved it, but they also abused it. And because it was fee for service, it ended up being an there was one MA that was full time managing the text line. But we were not getting paid for anything. And I knew that texting was something.
I love texting. I knew that it was something that I wanted. So I signed up with Spruce immediately. I am a fan of the portal. I use the portal heavily in my last practice. And I think that part of me wanting independence and autonomy also is reflected in a lot of my patients wanting independence and autonomy over their healthcare.
I love that In the portal, in Serbo, patients can self schedule, they can update their medication list, they can send me notes, they can update the specialist list, they can update their medical history. If they just had surgery, they can put their surgery in. They can, I mean like the, it is like an endless abyss of self-propelled things from the patient.
When I started this, thinking about what tech I was gonna use, I did start thinking backwards. I said, Okay, I have 450 patients and I have a friend in Whitefish, Montana. Morgan Coleman is a good friend for residency who started a dpc right when Covid was kicking up.
And I've watched her struggle with some of the tech that she's chosen because she grew. I, what is she, two and a half years in and I think she has 450 patients. So her growth was wild. But I've, she's been really honest about Hey, I hate this, about this piece of technology or whatever. And I really wanted something that was gonna be very hands off.
I wanted it to be self-propelled and self-regulated by the patient. I wanted a really clear delineation of how they were going to communicate with me. This is option one. This is option two. This is option three. And I think the cost was one thing that a lot of people like, They're like, Ooh, that's so expensive.
And I'm like, But so is staff. So if I can automate my workflows, So that I am not in there every day self-managing these things. Or if I can automate my workflows. And again, I'm talking like I'm one weekend. Okay. So ask me in six months how this is going. But so I ended up, my lawyer was actually the one that was like, Hey, I think you should really use Hint.
And I was like, But it's expensive. Hint was great to work with. They literally got me set up in two days. It was like a game day decision. But it's been so seamless. Like my patients schedule an inquiry call. Originally when my portal was not, when Servo was not yet customized to me, I had to use Calendarly, which has turned out to be a nightmare.
But patients self-schedule an inquiry call in Servo, I get a little alert that says an unregistered patient with an appointment. I add it to the schedule, it's pushed to my Google calendar, their information is pushed to Hint, and then it's pushed to spruce it's like com. Everything is like poof, it's done.
So I, I love that. And I felt like with Calendly I was managing you. Managing four calendars, trying to figure out what to put it in. One piece of advice that I do have for people that this is like a new headache for me. I have a personal email address and then I have an email address that kind of reflected my social media presence.
And then I added an admin email address for when I do eventually hire staff which I'm hoping will be a while that I can function, independently without it for a while. And then I had my email address associated with the clinic. So currently on a daily basis, like four times a day I check four email addresses, which is ridiculous.
So that is one thing that I would like re in your email addresses and figure out exactly what you want to go where from the very beginning, cuz I did not do that very well. But otherwise I feel like the tech that I've chosen has been pretty seamless with the process so far.
Love it.
And when it comes to making your emr have all those details that you need, or creating those text expander phrases how do you manage not getting overwhelmed with the minute things you have to do for your business?
Yeah, I did not expect, and again, I have to keep saying like I'm one weekend, so ask me, it's six months how I'm doing, but I did not expect the amount of mental energy. Drain in the first three weeks of the two weeks prior to me opening. And then this first, like my husband took a, I should send it to you.
He took a video of me a couple nights ago, just like completely nodding off with my phone in front of my face on the couch at night. And I'm so grateful that I'm not, I'm doing locums for a really limited number of hours per week that, that's, I'm thinking it's a temporary thing depending on how quickly I grow.
But I did not expect this amount of energy expenditure just mentally these first few weeks. I think that, and I was eat full disclosure, like I have not drawn blood since residency. It's gonna be a fun adventure. I was unpacking the lab stuff and I was like, What is this stuff? I have no idea because it's all I've never had to do it before.
So , I went, I texted with my old MA and I was like, Can you come help me? just, but I, acc tapping into those resources is such a, such an important thing. I definitely feel like the tech that I have chosen has everything that I need. I am not scrambling. There's no forms that I have been missing.
And I think that it, I, it would be a huge headache for me to have to create all of that from scratch. Instead, what I can invest my energy into now is expanding my library of patient handouts and expanding my, protocols for my weight loss program and ex, like the things that actually are going to attract people to my practice.
That's where I can invest my energy because of the choices that I made instead of, trying to dump all of this information into a rudimentary electronic medical record system. So I'm really grateful for the guidance that you gave and, that a lot of other people have given just because it's been a huge time saver for me so far.
Awesome. So far. And I hope that continues because, I think that sharing. Is an example of how you are working from the end, right? , and I say the end, but then that sounds a little depressing, but in terms of like your goal, I should say, your goal.
But in terms of I totally reflect on that every day when I'm like, Okay, I should have done a flu vaccine consent. Like last month, but I didn't. And so now I have to do one, and then when I get it done, it's like I never have to do another flu consent again. So it's so nice to be able to be in that place, but it's like you're, like you said earlier, it just be, be kind to yourself.
If something is like, Ah, darn it, I wish I would've done that before then you don't have to, you remember that you do not have to go through 16 committees to get the approval to, to change the process, and then you can just do it. And then, in terms of how are reflecting on what is going to make the biggest impact and how your practices represented through things like your workflows for obesity, d medicine and whatnot.
I think that, that really will just allow you to feel that autonomy. Even if it's even if it's like a subconscious type of autonomy just because you're like, Oh yeah. That's the form that I created because this is the way I practice medicine. So I love that. Yeah.
And in terms of now that you are in this first week of opening and you are having patients join your practice, how are you balancing getting the office ready with actively bringing patients in?
That's a great question. So I actually just started inquiry calls last week. And the turnout for inquiry calls was much better than I thought it would be.
I have had a few cancellations, which, it's a mental journey. I'm still fine. They still like me, Like I, it just, it may not be the right time for some people. Yeah, I am still, and again, I. I feel a little silly being on the podcast at this stage, but this, kind of precon contemplative stage that I'd like grad, just graduate, just like by the skin of my teeth graduated from.
The office has taken way longer than I thought it would. So right now I'm seeing people virtually connecting with people virtually, and they've been fine with it. They really have been quite understanding. So I opened my schedule for inquiry calls and I made the decision to do that.
There's a handful of people that I would consider pretty seasoned in direct primary care. and it was twofold. Number one, they really seemed to think that it filtered out a lot of the people that just signed up for a month or two months, to take the time to connect with you meant that they were making that extra step.
And then the other thing is that this is such a new concept here that it's like a to, it, it's this whole brain pivot that people have to do in order to actually grasp what you are offering and why it is different. And I wanted the opportunity to say that myself instead of ma them making assumptions and reading between the lines on my website.
But I opened my schedule up and it like filled up very fast for inquiry calls. So that's been great. I would suspect that I probably will have a bit of a plateau or a lull after like month two. But I won't complain if that doesn't happen. So this space took, like I said, flood. Purgatory in supply chain, like all the paint that I chose looks terrible and I don't have time to fix it.
So you know what? It is, what it is and we just have to move forward. Stick
on wallpaper. That's all I gotta say. Oh my covered up quickly. And the other thing I wanna drop there too is Black Friday, Cyber Mondays are coming up. So especially for people who are in and, Jaylen and I talked about this yesterday that I actually signed my lease last week for my space, that when we are.
Looking for things, starting out with what you need and then going from there allows us to just take a step back and not feel guilty about, Oh, I shouldn't have bought that, but also save your receipts. That's my other, that's my other advice there. But yeah, I love that you have a way of doing telemedicine.
You are getting paid for doing telemedicine as part of your practice, and then you can build out your spaces you need to use it. So that's wonderful. And now, reflecting on your autonomy as your core value in terms of what your balance and life looks like right now.
When you shared about how like your kids forgot their lunches and whatnot. In terms of going into the future, what do you plan on for your day to day? Are you going to be in the office every day? Are you going to be office hours? By appointment only, how are you gonna manage your day to day operations?
Yeah. This is one of the things that I have not completely figured out and I, I don't have that expectation of myself, I think that one of the biggest challenges that I've run into, and I think that you said this before too, is that I'm getting these phone calls. I don't have staff right now, and I'm not in the office every day and I'm getting these phone calls from like FedEx and they're like, Sorry, I mean I have to send you a package back to the warehouse.
And I'm like, But what is it I, Cause the, if you order samples or if you like Gene Site sent me the folders for collection kits. There's no tracking number. I don't get, I don't know when they're coming to the business. You can't sign up for text alerts for your business for package delivery.
And so that's been a struggle. My building has like a mailbox unit and then there's like a public. Space, but there's no person that's populating that, that space. It's just like a big lobby. And then my entrance is actually separate from all of the other entrances in the building, and so they can't leave the package at the doorstep.
And so that is gonna be probably one of my biggest challenges. My office hours, I, my, my honest long term goal is to keep it part-time. So at this point I'm planning on being open a full day, Monday and Tuesday, Wednesday will be my admin day. I'll volunteer in the kids' school and then if somebody has an acute issue, hopefully we can take care of it virtually.
I don't mind working on Wednesday. I just need to, clean my house and go grocery shopping Thursday. I'll work an abbreviated day probably six to seven hours in the office instead of nine. And then every other Friday I'll be open for acute issues. I think the mindset shift that has to happen, and again, this goes back to.
I think that there probably are people listening that are like, That sounds terrible that you're on all the time. It sounds wonderful to me that I'm on all the time and I get to take care of these people completely. I have lots of friends in medicine that does not drive well and DPC is not for them, and that's okay.
I, it took a little convincing with my husband to tell him like, Hey, You have to understand that these hours are just translated and they just look different. It's not that I'm gonna be working less it, it may actually that I'm working more, but it's just that I get to control when they are, instead of someone telling me like, Hey, sorry, you can't leave, and this actually happened last year.
This was the straw that broke the camel's back for me. Sorry. You can't leave at three 30 for six weeks to take your kid to track practice. You ha you have to use pto. And I was like, But I work through lunch and I come early and I stay late, and sometimes I talk to patients when I'm off and I, and they're like you just have to use pto.
And I'm like, Okay, , I'm done. This is not, this is not how motherhood and medicine are supposed to meet. There's no middle. It's just, it's all medicine. And so my hope is that my patient. I have been honest with my patients the whole time about how not my DPC patients in my last practice, what my frustrations were if I was having a bad day.
And a lot of it just came back to how administrative and corporate medicine was structured. And so I think that they are understanding and know that you know what, I may not get to your letter today. I may not get to it tomorrow, but I'll get to it and I promise that I'll get to it. And they know that.
And there's that, mutual trust that I think when other cooks are in the kitchen, if you will that they don't have that trust there to the same degree. Yeah, the balance is I think something that, that will be challenging for me. But I'm looking forward to the challenge.
I.
And you have people to bounce ideas and, thoughts off of too. So it's awesome. Yes. Now a question that I was super excited about because I was like, what does she gonna name her practice? What does she gonna name her practice? So you chose Thread Health, so please share about your choice of game and your method for branding.
I know you said you had some help there, but in terms of like when you envisioned your clinic, how did you come to choose Thread Health?
Oh my gosh. Okay. I just have to say that I live in a state where marijuana is legal. Therefore, the marijuana dispensaries literally took every name that I thought of. I made a list of like 30 names that I thought would be reasonable for practice, and they were all marijuana dispensaries.
And I kept coming back to when Covid happened, I had I had a few hundred followers on Instagram. And I just started talking on Instagram, like I just started talking, and I have a tiny little following comparatively. I have no intention of ever being a social media influencer. I like to show people my dirty laundry and show up all the time looking like a fright, but I show up authentically and I think that's maybe why people hang around.
So when Covid started, I just started talking and people started listening. There were a lot of people that, I went from getting 60 views on my stories to 800, 900 views on my stories. Which for not doing anything and just gabbing on social media that, that meant something to me.
But I, I kept coming back to the fact that what was happening on social media was this conversation thread. It was an ongoing conversation and, in a whole nother dimension that I needed something after the pandemic. To hold onto that was like a common thread between everyone. Like I had to find that thing that would continue to push me into rooms to talk about vaccination or talk about Hey, can you put your mask back on?
I don't care if you wear it, but my boss does or whatever the conversation was gonna be. And I had to find those things. Like I had to find the common thread and I had to find the thread of conversation that was happening to allow for consistency. And so I just came up with Thread Health and there were a lot of people that were like, That sounds like a fabric star,
But it drives and I like that it can be abbreviated, right? Like people, even my patients have started just calling it thread. But I think it, it's one of those names that you look at and you're like, Oh I don't know what that means, but my hope is that it provides both of those things that I can see the common thread among humanity in my patients.
And that, that the relationship that's built there is like a ongoing thread of conversation like you would find online
and, potentially a tagline to use as your marketing in the future. So I think that's awesome. Yeah. We said it really well. Yeah. Yeah. Going into week two of your practice, as we close, I wanted to ask, what does your strategy look like for the next week and the next month? What next things are you going to.
Yeah, that's a good question. I actually have a pretty busy week next week with inquiry calls.
I trying to find the cadence and the rhythm for how I'm gonna reach out to people and how I'm going to communicate has been harder than I thought it would be. It's funny that when you dream about all of these things, and I think I posted this in the DPC Women's Group, that that you're like dreaming about being able to be in control of your schedule, and then it actually happens and you're like, Oh wait a second.
I, this is me. Like I'm in charge of this. And so yeah, the next week I think is just full of inquiry calls. I have to get some of my new patients into the clinic. And then the next month I'm just gonna hold on, like we are gonna be outta town for Thanksgiving. And I'm, I, I. Strategized enough, I need to go visit the practices in town that were pretty steady referral streams in my previous practice for me.
And I, I do, I call myself a crunchy granola doctor. There are some things that are atypical that I recommend or prescribe. And so I think that it, a lot of it will just be reconnecting with people in the community. I'm not a huge fan of, like the door to door cold call sort of marketing.
Because I think that if I am going to create a business that's based on relationship, I need to lean into that a little bit more than just a brief interaction. But I, I. Some of the premise, especially with employers that, have expressed curiosity may just be meeting people where they're at and that may mean, going to their place of work just to see it and get an idea of the environment.
So I'm open. There's lots of possibilities that could happen in the next month.
Best place to be. So thank you so much Dr. Pritchard, for joining us today.
Thanks Maryelle. It was great to be here.
*Transcript generated by AI so please forgive errors.