Direct Primary Care Doctor
Dr. Wendy Molaska is a graduate of the University of WI School of Medicine and Public Health and is a Board certified family physician and a Fellow of the American Academy of Family Physicians. She has practiced full spectrum Family Medicine for over 20 years. She started her career working for the National Health Services Corps in rural Colorado until 2008 when she moved to Platteville, WI. She continued practicing rural full spectrum family medicine until she joined the University of WI School of Medicine and Public Health as an Assistant Professor and moved to the Madison area to continue her Family Medicine practice.
In 2019 she transitioned her medical focus to provide inpatient hospice care and in 2021 she left employed medicine to start her own direct primary care (DPC) clinic called Dedicated Family Care to continue providing full spectrum family medicine in the Fitchburg/Madison, WI area. In addition to her clinical practice, she has served on the Board of Directors for the WI Medical Society and was elected President this year (2022). She also serves on their Justice, Equity, Diversity and Inclusion (JEDI) Taskforce. Through the WI Department of Health Services she serves on the Advisory Council for the WI Council on Immunization Practices. Given her love of reading, since residency, she has also been involved with Reach Out and Read, an early pediatric literacy program that is based in primary care clinics, and now serves as Co-Chair for the WI Reach Out and Read Advisory council. She enjoys travel (when there’s not a pandemic) and has also completed multiple medical missions around the world.
Dr. Molaska Speaks About
Dedicated Family Care, her DPC in Fitchburg, WI
Phone (608) 305-4515
Email is firstname.lastname@example.org
ADDITIONAL PODCASTS/RESOURCES/ARTICLES FEATURING
Thriving in the Transition Season 3 Episode 3 https://podcasts.apple.com/us/podcast/s3-e3-going-out-on-your-own/id1500758427?i=1000548989320
The Pathfinder Podcast Episode 11 Sept 4, 2021 https://www.buzzsprout.com/1053559/9140503
Novo Live the Podcast Episode 3 August 9, 2021 https://novohealth.com/novo-live-the-podcast-episode-3/
Descant 9/28/2021 The Many Hats of DPC Physician Wendy Molaska https://www.descant.info/podcast/episode/4bf4e68f/the-many-hats-of-dpc-physician-wendy-molaska
https://www.youtube.com/watch?v=Y0C0SHAeRHo HealthCare Economics Summit in 2021:
Presented at OnRamp Healthcare conference in 2021: https://wisconsinhealthnews.com/2021/08/23/startup-leaders-eye-potential-to-address-health-disparities/
WI Health News Panel Oct 2022:
Physicians ‘between a rock and a hard place’ when it comes to navigating abortion law - Wisconsin Health News
Several of us DPC docs in the Madison, WI area were featured in the WI State Journal https://madison.com/wsj/news/local/health-med-fit/more-madison-area-doctors-providing-direct-primary-care/article_cea4739a-395f-56ac-9e18-98cff5c80ef8.html
Dr. Molaska features as President of the WI Medical Society:
Watch the Episode Here:
Listen to the Episode Here:
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Leave us a review in Apple Podcasts and Spotify to help others discover the pod so they can also listen to all the DPC stories so far!
Welcome to the podcast Dr. Molaska!
Oh, thank you so much Dr. Concepcion. I am so excited to be here.
And like we were talking about a little bit before we started recording, it was such a privilege to meet you, at the DPC Summit. This past July in Kansas City. So get your calendars out and start planning for next year because it is so amazing to be in the physical space with other DPC physicians.
So, Dr. Malaka, I wanted to get started with the fact that your journey has been one that is chalk full of perspectives from all. All aspects. You have been a patient yourself. You have been a physician in the National Health Service Core. You have been a physician in urban and rural settings in different states.
And so in terms of your experience from all those aspects of life, what drew you in to choose family medicine?
Um, So basically when I was like five years old, I already decided I was gonna be a doctor. And I never wavered from that. And a lot of it I think was related to the fact that I spent probably more time in the hospital as a kid than on the playground.
So I have more fan syndrome and have a lot of complications related to it. And yeah. One of the things that happened at one point in time was I had kind of a stereotypical god complex surgeon that when you're a kid is like, Oh, this isn't gonna hurt. And yeah, it, it hurt. I had a chest tube in and it wasn't comfortable.
And so at that point in time I told him, I'm gonna grow up and I'm gonna take your job. And what ended up happening though was like, I love too many parts of medicine. As I was going through my rotations in medical school where I was like, Oh my God, this is so cool. This is so cool.
This is so cool that I was like, I wanna do it all. And so the only thing that really seemed to fit was family medicine. So being able to do it all because yeah, , I couldn't decide basically. the other interesting thing about family medicine too, is you can kind of tailor it to what you want within that as well, so that you don't have to do everything, but it allows you to kind of pick and choose as well, which is, Yeah.
What I tell people as well when they're looking at different special.
In terms of you being a family physician and then you choosing to leave fee for service medicine and in May of 2021 opening up your direct primary care, I wanna ask, how did you even come to learn about Direct Primary Care as a
Actually I will credit a bunch of other DPC docs. So, in 2019 um, I, like, unfortunately, so many docs in fee for service was hitting burnout and was exploring what I was going to do from there. And I met Dr. Nicole Hemps with Advocate And she was talking about dpc, which I'd never heard of before, and I was like, Well, this is really intriguing, but I'm not sure yet and I don't really know enough about it.
And so from there started looking online and finding a bunch of the other DPC docs and then it got into the Facebook DPC Docs group. And of course there's like everybody there and everybody's so willing to share information. And then also met Dr. Amanda Primus Berger with Rut md.
And so she opened just a few months before I did, and we've kind of been each other's supports because we're, our clinics are about five miles apart down
the road from each other,
when you decided to. Take the leap yourself after, having a community around you, having a community online. what was the, Yep, this is the time that I'm going to leave you for service and open my dpc.
Yeah, so it was really interesting. So 2019, I had hit the end of my rope in fee for service family medicine. And I was still doing kind of full spectrum family medicine at that point in time, delivering babies, hospital, clinic nursing home, all of that kind of stuff. But I was within a large academic.
Center and basically, you know, anytime you come up with any kind of idea where it could lead to efficiencies or anything, it's like trying to turn the Titanic. It just doesn't happen. So got tired of pounding my head against the wall. And that's when I also had another diagnosis at that point in time medical diagnosis.
So I had was diagnosed with breast cancer. And that kind of makes you think. Okay, life is short and I'm done doing this job, and what am I gonna do from here? And so , the best choice for me was to do inpatient hospice with the diagnosis of breast cancer because I've always really enjoyed, actually both ends of the family medicine spectrum, the womb and the tomb.
And so I had an opportunity to do inpatient hospice and I was like, Sure, let's try. So while I was going through my treatment for breast cancer, I started working as an inpatient hospice doc, and I absolutely loved it. It. Amazing. And I really felt this was gonna be my like retirement job. I love the people I work with on a day to day basis.
I love the families, the patients, just everything except the administration, . And that's what always becomes the problem, right, is the administration. And initially it wasn't as big of a deal, but then Thing that happened in 2020 that a lot of us are familiar with something called a pandemic. And that's where things got really bad.
Basically, the administration all went home and were working from home and were doing Zoom and all of us on the front lines were taking care of dying Covid patients and other patients on hospice who are dying. And we were told, No, we're not getting ppe. No, you're not getting. That no, no, no. Oh, and by the way, even though all of your kids and spouses have all been sent home from work, and your kids are home from school and daycare and you don't have any options anymore for them, you now also have to work every weekend and all of this.
And again, it was one of those things where, you know, you, you're working in hospice, so what do you learn in hospice? Life is short. And so again, it took me until December of 2020, but I hit December of 2020 and I was like, this is actually affecting my own health and the health of my family. And as much as I wanna, support my patients and my family and my staff, I have to take care of me first, or I can't take care of anybody else.
So December, 2020 I quit inpatient hospice and started planning for my dpc, and then yeah, opened in May of 2020.
And when you say that you started planning from December, 2020 and then opening in May, 2021, what was that journey like? Did you have, you know, a loose idea of where you wanted to practice and what you wanted your value proposition to be?
Or did you really start solidifying an actual plan in December of
20? Yeah, it was pretty much solidifying an actual plan in December of 2020. So it had been in the back of my mind for, since, 2019 when I first heard about it. And my husband fortunately is super supportive. And he's actually done a bunch of startup companies.
He's kind of the tech guy with startup companies, so he's like, Eh, this is just another startup company. It's not a big deal to him. I'm like, Oh, it is to me, cuz yeah, this stuff brightens me and I have no idea about running a business or anything, but he is like, No, you. It's, it's not that big of a deal.
And yeah, he was very supportive as we started coming up with, yeah, what do I want this to look like? What do I wanna be able to do? Where do I wanna practice? How am I gonna set this up? And then, yeah, just going through all of the, the various steps and then using all of the, again, all of the online resources and all of the books that are available these days.
And yeah, all of the help. And, and that's the one thing that's really, really struck me with the D P C D community of Docs is. So willing to help each other out, whether it's, curbside on a patient or Hey, where do you get your exam tables? Or does anybody like dr. Primus Berger and myself, we just now like split a box of endometrial biopsy pips cuz we're like, I'm not gonna use these before they expire.
So here you take half, I'll take half and we can split it up that way. So
And what tips would you have if someone has, a fairly quick turnaround within six months between giving notice and opening their dpc for planning their own dpc?
My biggest thing was trying to figure out what needs to happen today and, and what, what is okay if it doesn't. And so we did a, I did a lot of planning and my husband again helped me with this is like, these are the weekly goals, these are the daily goals within that week and. Some of those things are just not gonna happen and, and what's at the bottom of that list so that if it doesn't happen today, it's not gonna, end up throwing a huge wrench into the system.
And so really trying to prioritize, what's the daily goal, what's the weekly goal, what's the monthly goal? Because otherwise, yeah, you can get bogged down in the details and get bogged down in all these little things that sometimes are just not the stuff that you need to be focusing.
And, being business owners, you and I know, and other business owners listening or future business owners listening will find out.
If it doesn't work, you can then change the next day. So, it's amazing to hear that again, just from December of 2020 to May of 2021, you opened your D P C, just incredible. And so when, when you think about that, Time. I wanna also ask, I, I get that you had a community of people around you in terms of other direct primary care physicians, and you also had your husband who was familiar with startups.
But in terms of the biggest fears that you had to work through, what were some of those fears that you had and how did you work through them?
I think. Probably attracting patients. So it would've been one thing, I think if I had left fee for service, family medicine because I think a lot of patients actually would've followed me.
And that would've, been a nice, solid starting place. But because I was coming out of hospice none of those patients really followed me . Um, But it is interesting because I have had some of my former family practice patients now find me in DPC and have signed up with me. And so I think the, the biggest.
Fear was, Yeah, how can I market this? How can I attract patients? How am I gonna get the, the patients to sign up so that I can make this a legitimate business and pay the bills, and then grow to the point where eventually I can pay myself and so forth.
Definitely. And when you talk about the, fear of people joining what actually happened in terms of May, 2021 you opened, Did you have a list of people on a waiting list who are waiting to join the practice?
Or did you start day one with zero patience and grow
from there? Yep. I started with zero patients and actually my first patient was a grandmother from Bolivia who was visiting family for like six months and ran outta insulin. And so what do you do if you're from a different country visiting here?
And you run out of one of your beds and normally what you go to the urgent care or the er, and that's just, without insurance, without any kind of being able to get insurance here, that's gonna just, be hundreds if not thousands of dollars. And then trying to go to a pharmacy, not speaking the language, not understanding how the healthcare system works.
So interestingly, This grandmother, her family that lives here knows my nurse Ingrid who Ingrid and I actually worked together in hospice before I stole her. And so Ingrid already knew about this whole concept of dpc. And so when her friend had this grandmother who was like, She's like, Oh, go sign up with Dr.
Malaka. And they signed up with me and we got the lady here, insulin. And then while she was here for her six months, she came in with all kinds of other issues that she decided since she had a doctor and it was easy to access me. She just came in all the time then. So she was my first patient. And from there it was it was beautiful in some ways because the Latino community in the Madison and Fitchburg, Wisconsin area is pretty tight knit.
And so, Aside from the grandmother, then the granddaughter who brought her in was like, Oh my God, this is amazing. Can I sign up? And, but I have insurance. So I'm like, Yeah, but you know, it doesn't, it doesn't matter if you have insurance, you can still sign up. So, so trying to do a lot of the educating.
But then, yeah, a lot of it was word of mouth from there. . And I would have to say I grew really, really slowly, especially during the first six months. But when I look back, for me that was actually okay because it really helped me figure out a lot of the business stuff. Because yeah, again, trying to get everything up and running in five months.
So there were a lot of things that I felt like I was missing or not doing. So then growing slowly allowed me to, to try and address that, Oh, I'm gonna need that. Yeah. And, oh yeah, I didn't think of this. So, I think that was helpful for me.
I love that, and I can totally relate to that in terms of, you, you don't realize sometimes in planning what workflow is going to work with your patient population because you don't know who's going to join your practice.
And then, like we talked about, pivoting, you, you have then the time to pivot and change your workflows so that in the future your workflow's nailed down. Who joins your practice, but I will say that that is one of the best word of mouth stories ever. So thank you so much for sharing that because I, I just, I love that it's like that was the best kind of marketing that you could possibly have.
I mean, we, we all are familiar with the power of word of mouth, but that is incredible that your very first patient was your, was your spark. So that's
amazing. And what's really interesting is it was one of those niches as well that I never thought of. But now I have a lot of these patients who they're visiting from Mexico or Guatemala or Brazil or India or Pakistan for, 3, 4, 6 months at a time.
Uh, And they need medical care, but they don't have insurance, they don't have coverage here, so what are they gonna do? And this is one of those, kind of interesting DPC things because I mean, on the one hand, I'd rather have patients who are, long term patients for years and years, but at the other hand I'm like, this is a great niche to have too.
Even though they're turning over is because how else are they gonna get care? Where are they gonna get this care? It's impossible when you're, here in the States and you don't understand the, the system. And that's actually what really surprises me with my patient population as well, is how varied it is.
So even the patients who currently live here, they're from Poland and Russia and I have Ukraine refugees. I have. Afghanistan refugees. I have patients from Iraq. I mean, it's, it's just so varied. I have, the whole world population in my one little DPC clinic that even at an academic fee for service site, I was like, I don't feel like it was as varied as this is.
And just knowing, on previous platforms you've shared about how. You, you revel in the idea of being able to use your position as a position to also impact via social justice your community. So I absolutely love that. And, and I hear you in terms of the churn might be different than a, than a practice with locals so to speak, but the fact that you were able to.
People who, are concerned about access to healthcare because of their immigration status, that that's not an issue. It's just you're a human being and I'm a, a human doctor, and so I can give you care. That's incredible. Love that.
Now, can you give the audience , a little bit of a picture as to what Fitchburg,
Yeah, so Fitchburg is essentially a suburb of Madison, Wisconsin. So Wisconsin is a very interesting state in that.
So I used to practice in Platteville, very rural community in the state. So. Wisconsin has basically the Milwaukee area and the Madison area are kind of our two big cities in the state. There are some other cities that are fairly good sized but the majority of the state is rural. So, we always kind of say, especially in Madison that it's kind of, one square mile of Liberalness surrounded by A bunch of Republicans, so that's why we're such a swing state as well.
So our little cores of city are more democratic leaning, and then our rural areas tend to be more Republican leading. So we're very swingy state. But Fitchburg is an interesting community in that it has kind of a very. Wealthy suburb area, but then we also have some very underserved areas in Fitchburg.
And so where my clinic is located is kind of on the border of the two so by some low income housing. And then I can actually walk to clinic from my house, which is about a mile away in, typical kind of suburbian setting. But yeah, my patient population then is a little more diverse I think, as well because of where it's located.
in terms of that location in particular, did you happen to have lots of choices when you were looking for a space or did that space happen to be just the perfect fit? All of right out of.
Yeah, so it was interesting. I think that was one of the big things that I didn't realize was trying to rent commercial.
That was one thing I wasn't prepared for. So I figured it would be more like, buying a house or renting an apartment where you just go out and see something and you do a lease and you're all set to go. And it's not like that. It takes a lot longer. And especially if you have to consider a build out or something like that than all of the negotiations and then the time to do the build out and everything.
So I was not at all prepared for that. And I think that's also what pushed me out to make, cuz I felt like I was ready to start a little bit earlier. But I wanted to start in a, in a building or in an office. So I was working on one lease and talking to the landlord about a build out and doing all the negotiations and stuff.
Got to the part where we were about to sign the lease, had worked through all of the build out and who was gonna pay for what and so forth. And then the lease came back to me with. Way more on there where I was paying for a bunch of the build out that we hadn't talked about. And part of that was just because all of the construction prices now during the pandemic had gone up so much that apparently the landlord wasn't prepared for it.
So then he just decided, Okay, well I'm just gonna pay this much and then you gotta pay for the rest. And I was like, No, that's not what we had talked about. And it was one of those things where you wanna try and keep your overhead as low as possible.
So this was something that I was like, I did not wanna pay this much for a lease. And so I dropped that one, let that I did not sign that lease. I let it go. And then I was kind of back to square one and I was like, Oh my God, now what am I gonna do? And I happened to just drive around the neighborhood and there was an office building that said, for.
And so I called them up and they're like, Well, we have a one room office just a one room suite for rent. I went and saw it. It was a great size. It was in a nice location. The building seemed quiet. And so I was like, Yep, let's do it. They wanted to do that for what was the minimum, like two. And I was hoping to get into something, still something slightly larger sooner than that.
So I did take out an 18 month lease but was able to start then in the one room suite. And it was, it was great. It was awesome. It, it was interesting to, to. Have patients come in there and not be turned off by the fact that it was just a one room suite. They'd come in and they'd look around and they'd be like, Oh, wow, this is different.
And I'm like, Yep. But then because of the, relationships you're building and the care that you're getting, nobody seemed really turned off by the fact that, hey, there's an exam table there and your computer there, and your centrifuge back there. And so that was really good. But I did keep looking around at that point in time and my realtor was really good about saying, Hey, this just came available.
Do you wanna look at it? And so, I did go look at this other space, which was seriously two blocks from the one room place that I was in. And the landlord there was amazing. We didn't have to do as much build out and the price was right. And so, I ended up taking that one and moving it in january of 2022. So this year. Yeah. And so still had the lease at the one room office. But ended up getting really lucky on that too cause I was able to sublet it to somebody else. So that was super helpful. But now, yeah, we're in this nice new office with what do we have now?
We have kind of a little reception area. An office where my desk is, and then I have what I affectionately call the consult room, which is kind of a, a table and chairs because then it's just more comfortable to sit and talk to people around a table rather than having somebody up on an exam table and stuff.
And then what we call the procedure room, cause it's one of the larger rooms and it has all kinds of it has a sink and all kinds of counter space and whatnot in there. And then two other exam rooms and then a little kitchenette. It's super cute. I love it. , I feel like a, a grown up doctor now with my own space.
That's amazing. I love it. And in terms of the square footage of your space, can you give us an estimate as to how big your space is currently?
Yeah, So, the current space is about 1300 square feet,
when you were planning and then you opened how did you determine your price structure and has that changed since you've opened?
Have not changed the price structure at all. Determined it just basically by, yeah, looking at kind of our surrounding area here in Madison doing calculations based on, what my overhead is. What I'm hoping to make potentially as a salary and. Yeah just looking at other DPC docs and stuff too, I think was a big thing, is just kind of comparing to what other people are doing and then taking into consideration, where we are located and so forth.
And one of the things I wanted to ask you specifically was the pricing for children. You have the a at your practice, children are able to be independent members without a parent for an additional $10. Can you share a little bit about how you came to that particular part of your pricing?
So that, I just felt like if as a family practice doc, it's just so much easier a lot of times to take care of the whole family. You just know everybody and you know what's going on with everybody. And so I have children at like, a lower pricing structure with the family just because it's a little bit more difficult I feel like to have a child that's just kind of independent without the parents being part of the, the practice.
And. I don't know that it does actually make a, a huge difference in the long run. But it just does seem perhaps that when I compare my families to the individual kids that I have that I do get more. Contacts and more questions and emails and texts and stuff from those that don't have family members in the practice.
And I'm not a hundred percent sure why that is. So it just kind of helps cover for that a little bit, I feel like. And.
You had done an interview with your local alderman and you guys were talking about what does Fitchburg need in terms of like you were mentioning, a community center and transportation improvements.
What does Fitchburg need in terms of, medical care and , how did you tailor your DPC to the needs of your community.
Yeah. And so, most of my career I spent working in rural areas doing full spectrum family medicine, and that's what I really enjoy. And so that's what I brought with me back to this clinic is I wanna be able to provide pretty much, as much as I possibly can, because so many of my patients are underserved, have absolutely no insurance.
Have no other options. And so the more that I can do for them, the better off they're gonna be. And at the same time, I just like doing so many different things. So I do a ton of women's health because again I was usually the only female practitioner in the rural area, so, I did a ton of women's health, so, The other day I did a coloscopy.
I have an endometrial biopsy scheduled for this coming week. I did ALANON insertion the other day again too. And I'm taking out an i u D for somebody next week who's hoping to get pregnant again. But everything as, as well from diabetes care and hypertension to skin biopsies and anything in between.
Just to try and provide whatever we can because like I said, Fitchburg is kind of this weird demographic of having, kind of the more wealthy population and then a very underserved population. for
those patients who don't have insurance and who are part of your practice, if they were to need specialty care
do you have a connection with cash based specialists in the area?
Yeah, so what's really hard in Wisconsin in general, but in Madison in particular is that it's a lot of big systems. So, the big systems have their own insurance and then you're kind of stuck there If you don't have insurance it's kind of hard to send somebody into these systems because the cash based prices are not great.
So I often am actually sending patients. Sometimes a little bit of a distance away to try and get to independent practitioners who have cash based practices. So a lot of my radiology currently goes to the Milwaukee area or Rockford, Illinois area. So it's about an hour drive for my patients. But that way I can get cash.
Pricing for them. I have a cardiology group that, again, is about an hour and a half drive up in the Appleton area, but they are amazing to work with and do cash based pricing. Otherwise there is, in Madison, there is a. Free specialty clinic. So for those patients who absolutely don't have insurance they're not on Medicaid, they don't have any kind of insurance, they can actually be seen at the, the free specialty clinic.
And so there's certain specialties that are covered there. So I've sent patients there to see like e n T and pulmonary and general surgery and stuff. And then they work with the hospitals to say, Hey, you're seeing a general surgeon for your gallbladder. They'll then work with the local hospitals to get cash based prices with discounts for these patients.
So, Great. And
in terms of if a person were practicing in a community similar to yours where specialty care or, cash price imaging were available at least at a little bit of a distance away, how do you recommend people establish those connections to cash price? Imaging centers, cash, price, specialty.
Yeah, so that was I think one of the things that I liked again, about kind of starting slow with DPC is that because I had slow patient growth, I was able to start just kind of looking for these things. And some of it was just Google searches and then making calls and meeting people. And it's actually worked out really well because in talking to especially one of the independent radiology groups in the Milwaukee area that group I was then we talked with Dr.
Primus Berger and they realized they're more and more DPC starting in the Madison area. There's now a group of orthopedic doctors that are leaving one of the big systems here and starting their own independent practice. There's a couple of pain specialists here that have an independent practice, and so a lot of these people use imaging.
And so now this imaging group in the Milwaukee area is looking at potentially coming to Madison to open up shop, which would be amazing. But a lot of it was honestly just, yeah, online. And then kind of cold calling and seeing, Hey, can I talk to the clinic manager or somebody about cash pay pricing?
And some of it was through my, my connections just because I, I did undergrad and med school in the Madison area. And then came back to work for the University of Wisconsin Madison. And so you make a lot of connections. And then I also use my connections through the Wisconsin Medical Society. So once you start to, just know different physicians around the state, you can just start calling them up and seeing what they recommend or who they know and stuff too.
just to put a shout out, and a congratulations to you, you were elected and are the current president of the Wisconsin Medical Society. So can you give a little bit of history there as to how did you come to be involved in the, in the medical society in Wisconsin?
And what did your role look like before becoming president, and how has it changed since becoming
president? Great questions. So I actually started back in medical school as the student representative to the board of directors for the Wisconsin Medical Society. And so I was on the board of directors as a student.
And that really got me involved in organized medicine and especially the advocacy that you can do through being involved with organized medicine. From there I did residency in Minnesota and then was with the National Health Service Corps in Colorado before moving back to Wisconsin. When I came back to Wisconsin, I was in rural Platteville area and they needed a delegate to the House of Delegates.
From that area. And so I raised my hand at that point and nobody else did. So I was able to then become a delegate to the House of Delegates for the Wisconsin Medical Society again when I moved back in 2008. And then in 2012 I got elected back to the board of directors. And so sat on the board of directors for three, three year terms before throwing my hat in the ring for president and then being elected.
Last year I served as president elect and now this year as president of the Wisconsin Medical Society. And then next year I'll be past president. And then they'll probably kick me out cause I've been around for so long. . But yeah, my, my the trajectory of it has changed a lot. So on the board of directors, obviously there, we do, board meetings and the House of Delegates and a lot of advocacy and stuff.
But it is not as intense, I would say as being president elect and now president. And I think the majority of that is, I didn't realize how. Much time I would spend doing various interviews and advocacy and helping with amicus briefs and all of the kind of stuff that we do for advocacy.
But the biggest thing is honestly the Dobs decision. So Wisconsin is under a 1849 law. Made abortion a felony unless it is to save a woman's life. So not for the health of the mother, for the life of the mother. So any, the mom isn't prosecuted, but any physician or other person providing an abortion, unless it is to save the life of a mother is prosecuted as a felony.
Can go to jail for up to six years and have a bunch of you. Thousands of dollars in fines. So we, as of the Dobbs decision, stopped providing abortions in Wisconsin except to save the life of a mother. But were between a rock and a hard place as physicians. Um, Because if. You do provide an abortion that's not to save the life of a mother.
You're prosecuted as a felon and you have your license taken away, and you need a criminal defense attorney. If you wait too long because you're waiting until the life of the mother is at risk to perform this abortion, then you face a potential malpractice charge. So what are you gonna, what are you gonna choose here?
So it's been really difficult. And it's been. It, it was, it's been way more than I anticipated in terms of how many interviews I've done, how many panels I've sat on how many articles I've written how many people I've talked to. So it, it's like I have a second job. And this is a volunteer position as, as the president.
So it's like, trying to balance sometimes being the DPC doc and then doing the stuff that I'm doing for the medical society because it is so important right now.
And in terms of your position, especially your position as a direct primary care physician, when you talk about and highlight direct primary care, as, part of what you do when you're talking at, the state level, What types of discussions do you have when it comes to primary care and direct primary care separate from, the DOBS discussion?
Because, DPC definitely is, is something that is very bipartisan in this country. But when it comes to making an impact and bending the ear of a person, no matter what political party they affiliate with, what have you found strategically to be helpful when it comes to educating others at the state level about direct primary?
Yeah, so, I was able to, so Wisconsin is still working on its DPC laws to have us recognized as not insurance. So we were able to get a hearing in the house committee this past year. So I sat in on that and provided testimony for that. And the big thing that I've realized, especially working in politics, is that, yeah, you have to be able to play both sides of the aisle.
So when you speak to the legislature about dpc, it's like, what's gonna appeal to the g p? What's gonna appeal to the ds? One of the fights in our state is to expand Medicaid coverage for postpartum women for, to cover a full year of postpartum care while they're still on Medicaid. Generally what we see is the G o P side does not wanna do that.
The Ds want to. And so one of the things that we talk to the g o about is like, Hey, if you don't wanna. Been Medicaid then, DPC is a nice option. We can help these people who are kind of falling through the cracks who, don't qualify for Medicaid or who otherwise don't get insurance from their employer.
So here's a nice option, but this is why we need to be protected as dep c docs. For the ds. One of the things that I like to emphasize is, especially like with my practice, how varied it is. And we actually have a non-profit DPC here in Madison as well. So Dr. Mike Klaus, our Lady of Hope does 50% of his care is charity care.
So to appeal to the Dems, I have a very underserved population and I believe that they're getting better care and honestly, some of 'em come in telling me. They don't go into the system because of the way that they've been treated before. And so being able to appeal to both sides of the aisle, I think is huge.
And really emphasizing, you how we are working to help take care of their community. And you know what that looks like for individual legislators.
And going back to your position as the president of the Wisconsin Medical Society and having, two big things on your plate with regards to women's health and the DO'S decision and. Direct primary care.
Do you ever find anybody who is at the state level, not listening to, you as a whole person because what you've shared or during an interview or written an article about about direct primary care or the job decision has swayed them and it's difficult for you to bend their ear for the other topic at.
Yeah, so what I try and do is always try and bring everything back to whatever points we can agree on. And so I've had actually other physicians in the state who have come at me saying, know, abortion's wrong. And we, we, this is a good decision that we're back to 1849 and we should not be providing abortions and blah, blah, blah.
And I'm like, Okay, I get that. Whatever your beliefs are, you shouldn't, you don't wanna provide abortion. But my concern is that the doctor patient relat. Would you agree that the doctor patient relationship is kind of, the the end all, be all of of what we do? Well, yeah. The doctor patient relationship is the most important.
I'm like, well, what this is then what the stops decision is, is basically saying that this law is saying that. The legislatures have the right to get involved with that doctor patient relationship, and that's not right. And so what's next? If they can say that this doctor patient relationship you can't have, what's the next step?
What next are they gonna take away from that doctor patient relationship? And so by the time you get to the end of the argument, I had this doctor being like, Oh yeah, okay. Well, I. But you know, it doesn't mean that abortion's, right? And I'm like, yeah, you can, you can believe that abortion isn't right, but I think we need to still protect that doctor patient relationship.
And then the same thing, talking about DPC and stuff too is like trying to always get people back to, what we can all agree on. And for the same thing with dpc. I think a lot of us will go. The reason that we're doing this is that doctor patient relationship, I wanna be able to have conversations and get to know my patients and provide the best care that I can.
And so what gets in the way of that is, all the insurance, all of the prior aths, all of these other things. And so if we can agree that. We want the best care and that best doctor patient relationship. Then again, we can talk about either of these things and it all comes back to that doctor patient relationship.
And so trying to always find the common ground which is a lot of, sometimes hard to do, but most people, if you'll be, if you can find that common ground, they're gonna listen.
And from your vantage point as the president, I, I wanna ask. Getting, the, the future generation of direct primary care physicians into the world of direct primary care, what do you see as challenges and how has Wisconsin as a state overcome those challenges to get people, attracted to pediatrics, internal medicine, family medicine, to primary
Yeah. So one of the other things that just occurs to me and stuff too is like, people are like, Well how did you even get to be president? When you're an independent doc doing DPC or whatever. And I always joke, I'm like, Yeah, they didn't vet me very well. But I think a lot of it goes to, yeah, just continuing to get more and more of us involved.
So, Dr. Amy Doherty with Clark Care. We now have her on our board of directors with the Wisconsin Medical Society. So we're bringing more people in. And then I think the other part of this is reaching out to the students and stuff. So I have medical students that come out to my clinic. I'm hoping to have residents at some point in time.
I have pre-med. That have been coming in who have, of course never heard of this model. And so a lot of it goes back to education. We educate, individuals and employers, and now we educate, medical students, pre-med students, residents about, a DPC model so that when they're thinking about, Hey, I'm in medical school, what should I go into?
They can see other options and think that, hey, Maybe family medicine is the right choice for me, Maybe it's not gonna be as big of an issue. And I think some of the things that we need to look at as we go along are, how do we make family medicine more attractive for students in terms of, less debt?
How do we help them to set up DPC practices or join existing DPC practices where they can be supported? What's really interesting right now that's happening, Is through the Department of Family Medicine at the University of Wisconsin Madison, they are looking at what other options are there for primary care?
How can we readdress the primary care shortages and needs? And so I met with Dr. David Rankle from the department who's the chair, and he. Talking, Well, yeah, DPC and team-based care and how do we make this, more tenable for more and more people? And so, yeah, it's really interesting to see that there is some movement here and especially, yeah, it's even starting to come from the Department of Family Medicine, so, That, that is not
a small department.
So , that, that's awesome to hear. And has there been any movement in Wisconsin to look to pay a, a DPC physician like a physician who chooses FQHC after residency or Indian health?
Yeah, we haven't really seen any of that yet. Unfortunately. And so that'll be something that I think, comes the other argument that I have and, and part of this is just, kind of from my own journey as well, is that when I went from residency training to the National Health Service Core and um, to an fqhc I came out of it without any debt because that's what I was there for, which was great.
But the other thing that I found was really great was because I was on such a learning curve coming outta residency, when you get plunked into a rural area, you do have the support of some other family medicine docs there, but it's you or no one sometimes. And so we were doing C-sections and resuscitating newborns and all this kind of stuff.
and it was great learning opportunity. So there's also a part of me that says it's not necessarily a bad thing to go into fee for service, to go to an fqhc, to go to the National Health Service Core and say that, yeah, I'm gonna do this for, 2, 3, 4 years, get my debts paid off, and get a bunch of experience.
So that I can then go and do dpc. So there's something to be said for that as well. And I know that's not for everybody and everybody's journey is gonna be different. But yeah, from my perspective, there's always something to be said for, having all these colleagues around you when you're still, new into to practicing medicine and stuff as well.
Definitely. And I think that that's where things like CME that's targeted to like you, you do colposcopies and endometrial biopsies. Knowing that even as a physician out of residency, you can still learn skills, You can still become proficient and provide if, your community needs a, a particular service.
And going back to, organized medicine and being part of your state medical society. When you talk to other people who are like, eh, my medical society isn't really that active.
I mean, you gave us a great example that, you were, you were running pretty much an opposed after coming back from the National Health Service Core.
But why should people think about joining their medical societies and
what are some of the things that people. Could affect change on if they were to join their medical societies.
Yeah, so I think there's a lot of legislation that people don't understand that medical societies are weighing in on, and that we as physicians really need to have a voice in. And this is something where we do a terrible job as physicians.
A lot of us are like, Okay, yeah, I joined the AMA or the A A F P or my Med society or whatever. But we don't actually then do anything with that. We don't actually contact our legislators or do any of that kind of stuff. And it is a big deal to actually contact your legislators and give them your opinion of different legislation.
So for, Right, right now, one of the things that we're working on, Isra so there's a bill up saying that, yeah, Cram should be you. Available here in Wisconsin and blah, blah, blah. And we're like, No, this isn't a good idea. Um, So we've been talking to our legislators getting out basically what we call our legislative alerts to tell people to call their individual legislators.
And we give them a lot of times the script so that if you've never done this, Before here's what you say, here's your legislator. You go to this website, you can figure out who your legislator is. And I think a lot of this is really important on the state level as well as on the federal level because there's a lot of these individual bills that a lot of people don't know are happening.
Everything from CRA to, there were a bunch of we just got legislation through to legalize fentanyl test. Because they used to be seen as drug paraphernalia here in Wisconsin and you could be address arrested for having those. Now because of the opioid epidemic and the fentanyl lacing and stuff we've gotten fentanyl test strips to be taken off of that drug paraphernalia.
But again, it was us as a medical society also weighing in on this. To be able to say, credit I'm bad, Fentanyl, test strip's good. And providing that feedback. So I think it is hugely important doctors become involved. And yeah, the more that you can do locally the. Better off you are in the long run.
And again, a lot of this goes to just help your individual patients. And anytime you can bring individual stories as a physician, Hey, I'm a practicing physician. This is what I actually see. That carries huge weight with legislators who you know mostly are non-clinical and have no experience.
And knowing that this is your year of being president and next year you're going to be the immediate past president, looking to the future at your DPC at Dedicated Family Care, what do you envision going into next year for you and your practice?
Oh, next year I hope it'll be a little bit more sane.
Yeah, some of it is honestly just the, the random like interviews, Hey, can you do an interview with my most recent one was with Time Magazine. I was like yeah, I want to, But when so yeah. Uh, Some of it'll hopefully be more sane. I also do a couple of other things. So the next goal for me, I think, is to work a little bit more with reach out and read.
So this is national program and I think DPCs are uniquely poised to be able to offer reach out and read at their clinics. Because we also have more time to spend with our patients so we can talk about, early relational health as we give out books and stuff. So, I'd like to focus more on.
And then just focus on my patients and serving my community a little bit better as well. So since I was able to hire my nurse, Ingrid, who is amazing and she's also a certified medical interpreter um, being herself originally from Bolivia we are having a growing Latino population which makes us both really excited, but hope to also reach out to other communities.
We have a. Growing LGBTQ plus population as well, which is really amazing. And so, yeah, just keep hoping to reach out to more and more different populations. The other thing I would like to do at some point in time is provide more. Subsidized care, for lack of a better word. So I have a couple of patients already who have donated money for other people's memberships.
So trying to figure out, yeah, Robinhood model or non-profit or what direction I go to be able to provide a lot more of that care as well.
Amazing. And in closing, because you've been through a ton more than you expected for this year, what do you envision for balance in your life next year?
Because you've shared publicly how you love to be outside I, , I'm totally pulling this from your interview with the alderman, but you know, you talked about your asparagus and your apples and I'm here making dinner and I'm like, Man, I wish I was in Wendy's backyard, cuz I don't have any of that produce in my fridge.
But what does balance look like for you? Because you, you have all of this crazy experience that you can potentially say, like, my boundaries are easier to create because I. Crazy looks like with being a doctor and being a mom and a wife, and all the things. What does next year look like in terms of
Yeah, I do hope that I am able to balance a little bit better. And some of that is just the slow down again of interviews and panels and other meetings and so forth. Just because I do feel like I miss. To out a little bit. I hadn't anticipated being this busy. And so my, my thought this year was gonna be, Oh, I get to spend all this time in my garden.
I'm doing dpc, so I'm just not gonna schedule patients on, certain days or after certain hours. So I can leave early and go pick up kids and then be in the yard and do all of those things. And that broke down a little bit this year. And there's a part of me that's okay with it. And then there's a part of me that's like, I still need to continue working on boundaries.
And I think that's something that we all need to do is that yeah, we can just easily take on way more than we should um, because we we're doctors and we do that and, and we try and help everybody and we gotta be everything for everybody. So yeah, next year I hope to again, yeah, spend more time in my garden.
Play with the kids more. They're always great helping me plant and now that they're older picking apples and doing all of that kind of stuff. So, yeah, just continuing to work on boundaries and balance. But it's been good. It's been crazy. But yeah, I think maybe next year we'll slow down a little bit.
you so much Dr. Mola, for joining us
today. Oh my gosh, thank you. I have had a great time. I. I love listening to your podcast. I listen to it as I walk to work on my EarPods .
Next week, look forward to hearing from Dr. Brad Brown of Strive Direct Health in Erie, Colorado. If you've enjoyed the podcast, tell someone about it. There are still lots of physicians out there who have not heard about dpc, and you can change that trajectory. It also helps others to find the podcast. If you leave a five star review on Apple Podcast, Spotify now as well.
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*Transcript generated by AI, so please forgive errors.