Direct Primary Care Doctor
From Dr. Liu:
I was born in Taiwan and moved to Ames, Iowa, when I was ten. I’ve since loved the Midwest, and I’ve been in St Louis since late 2014.
Medicine for me is a calling to serve God and serve people. I chose family medicine because I love taking care of patients of all ages, and I love the continuity and connections I can make while walking through life’s ups and downs with people, to be there as a resource and an encouragement during times of uncertainty and fear, as well as during times of health and positive changes.
I enjoy working with my patients as a team to help them take better care of their physical, emotional, and spiritual health, so they can enjoy their life and pursue their dreams with their loved ones over the years.
HER STORY IN HER OWN WORDS:
HOW DID THIS HAPPEN? From Dr. Liu's Website
I became a doctor because I wanted to help people, and that was true of most of the doctors I’ve met over the years. I am thankful God led me to become a family doctor, and it has been a privilege to take care of a full spectrum of patients: babies and elderly, men and women, healthy and sick. I am humbled by the trust patients had shown me, and as I believe every person was made in the image of God, I try to treat everyone with care and respect.
Somewhere along the way, the time I spent with patients became shortened and pressured, as demands of administrative paperwork, insurance- and system-imposed regulations and checkboxes, and involvement of multiple parties like pharmacies led me to spend more time on paperwork than seeing and caring for patients. How could it be the United States of America spend the most in healthcare but not be the healthiest among developed nations? How could it be that caring and dedicated doctors were so bogged down with paperwork and being told by non-medical people how to practice medicine that many were either leaving the work force or committing suicide?
In July, 2018, I attended a medical conference and learned more about a different medical practice model called Direct Primary Care. For the first time ever, I left the conference crying because I saw hope for patients to get better care outside of our current confusing medical system, and I saw hope for my friends in medicine to not be data entry paperwork specialists anymore but to be the medical doctors they were trained to be. When the speakers presented data showing patients in Direct Primary Care models over time became healthier and spent less money on healthcare, I felt it would be unethical if I didn’t try to offer patients this service, especially if the only thing standing in the way was my fear of opening a business. It was in the mixture of being inspired and being terrified I started contemplating the possibility, and the name came to my mind even before I reached my car: Olive Branch.
To offer someone an olive branch is to give grace and offer reconciliation. In this broken healthcare system and broken world, we all need grace and need to give grace, in order to reach our common goal of health—individual and community health. Doctors need to give their patients grace for not being able to comply with medication or lifestyle recommendations. Patients need to give their doctors grace for being swamped in paperwork and regulations that they were not able to get back to them promptly or “squeeze them in” the schedule anymore. Doctors and clinic staff need to give grace to administrators who make policies that don’t work out well on the clinical level and realize we all have good intentions and the common goal of taking care of patients, but we are considering things from different perspectives, so we need to work together more effectively. Administrators need to give grace to clinical staff and not assume they are lazy when they push back on certain new requirements because they are already working hard to take care of patients and trying to meet all the existing administrative demands that take time away from patient care. Primary care doctors need to give grace to specialists, and specialists need to give grace to primary care doctors. None of us are perfect, but I believe most of us can empathize and try to abide by the Golden Rule. Very importantly, we need to give grace to ourselves.
I know Direct Primary Care is not for everyone, and it will not solve all the problems of our current healthcare system. I had considered if it was unethical for me to leave my panel of 1200 patients to pursue Direct Primary Care and have a goal of 400 patients, when there was already a deficit in access to primary care doctors. If others could thrive in this fee-for-service, insurance-driven clinic setting, why couldn’t I? If some family doctors could see 30 patients a day, why couldn’t I? I finally came to accept I simply couldn’t. I couldn’t just refill blood pressure medications for a patient without discussing lifestyle challenges or stressors that were causing sleep problems and affecting his blood pressure. I couldn’t just do a routine physical without truly reviewing a patient’s chronic conditions and evaluating her lifestyle habits to advise on how she could become healthier physically, emotionally, socially, and spiritually. All this took time I didn’t have in the current system, where most doctors were being asked to move to 15-20 minute appointments (and 5-15 minutes of that time could be taken up by nursing staff doing their part to meet administrative requirements). I came to realize I could not continue practicing medicine in the current healthcare system the way it was, so if it was between quitting medicine completely or to attempt opening a Direct Primary Care practice to show my support and faith in this model and movement, then I gave myself the grace to accept I could only take care of 400 patients at this time, but, by God’s grace, I would be able to take better care of them.
So this is how Olive Branch DPC came about. I officially started seeing patients on 9/10/2019, and it continues to be a humbling and exciting journey as I continue to improve the clinic to better serve patients.
EDUCATION
Bachelor of Science in Biochemistry from Iowa State University
Doctor of Medicine from University of Iowa Carver College of Medicine
Via Christi Family Medicine Residency Program in Wichita, KS (Graduate Medical Education of University of Kansas)
MEDICAL EXPERIENCE
Locum tenens work in rural Kansas, 2012-2013
Urgent Care in Wichita, Kansas, 2012-2013
Medical volunteering in Niger, a month each in 2012 and 2014
FQHC (low-cost clinic) in Wichita, Kansas, 2013-2014
SSM Health Medical Group in St Louis, Missouri, 2015-2019
LANGUAGE PROFICIENCY
Fluent in English and Mandarin Chinese
Know a little bit and would love to learn more Spanish
CONTACT:
Email: DRKATYLIU@OLIVEBRANCHDPC.COM
Phone: 314-207-2810
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TRANSCRIPT*
Direct Primary Care has helped me enjoy being a doctor a lot more and it makes me feel like I'm taking care of my patients again. It has given me the best work life balance I've had since residency. My name is Dr. Katy Liu of Olive Branch DPC, and this is my DPC story.
Dr. Katie Lou was born in Taiwan and moved to Ames, Iowa when she was 10. She obtained her degree as a bachelor of science in biochemistry from Iowa State University, and then earned her degree as a doctor of medicine from University of Iowa Carver College of Medicine. She attended residency at Via Christie Family Medicine residency program in Wichita, Kansas, and has been in the St.
Louis area since 2000. Medicine for her is a calling to serve God and serve people. She chose family medicine because she loves taking care of patients of all ages, and she loves the continuity and connections she can make while walking through life's ups and downs with people. To be there as a resource and an encouragement during times of uncertainty and fear, as well as during times of health and positive changes.
She enjoys working with her patients as a team to help them take better care of their physical, emotional, and spiritual health so they can enjoy their life and pursue their dreams with their loved ones Over the years, she saw her first direct primary care patient in September of 2019.
Welcome to the podcast, Dr. Thanks for having me, Dr. Conception. ,
Katie, could you start us off with this amazing quote from your website that really, Anybody in Direct Primary Care can really relate to, especially given that we're recording right after Nuts and Bolts Summit 2022 has wrapped up. A lot of people are feeling that, wow, I am so enthused about Direct Primary Care now what do I do? So, can you please go ahead and read this statement that was just so incredible on your website?
, So I'm talking about the Direct Primary Care Summit that I attended in 2018. So from the website, I. When the speakers presented data showing patients in direct primary care models over time became healthier and spent less money on healthcare, I felt it would be unethical if I didn't try to offer patients the service, especially if the only thing standing in the way was my fear of opening a business.
It was in the mixture of being inspired and being terrified. I started contemplating the possibility and the name came to my mind even before I reached my car, Olive Branch.
It's so like I, I feel that anybody who has been to Direct Primary Care Summit is just thinking back to their own experience, sitting in the audience and being like, Yep. This is my tribe. This is what I'm going to do. And having all those feels, including the how am I gonna do this? The, The terrified part.
Right. So can you bring us back to 2018 and give us a picture of what did your life look like when you were going to this conference and sitting and being inspired?
Sure. So leading up to that, I finished residency in 2012 and I wasn't sure what exactly what I wanted to do because I was kind of burnt out at the end of residency, which sounded terrible.
But what I did was I took a year sort of off, but sort of explore different options. And I did locum tens for a year, but with the spare time, I actually traveled to And West Africa and I travel back to Taiwan where I was originally from, try to explore different potential medical missions options.
But during that time I was led to still stay in Wita, Kansas, where I trained a little bit longer. So I worked there. For a year at a federally qualified health center. And then after that I moved to St. Louis, where I became an employed physician at a big hospital system. And throughout all those years leading up to that, I have begun to realize that whenever I was employed, whether it was at the FQHC or at a system, I was just an employee.
It was not the leader that we were taught and trained to be. Even though we carry that responsibility, and I'm sure many people were, are familiar with the struggle of wanting to take care of patients, but not being able to because of what insurance says or because of the limited of time given to us and not having the right support because we don't pay the clinic staffs, they need to clock out at a certain time, even if we still have two or three patients waiting, for example.
And so leading up to that point, I was feeling very frustrated. And feeling like I guess I was feeling inadequate and felt like I was not being a good doctor because I couldn't see 20 patients a day. I couldn't fit in a chronic follow up visit plus an annual wellness visit, plus a risk adjusted visit all in one.
And at that point I was also feeling I could get good at it, but I don't want to . And so it was kind of in that struggle that I came across the DPC Summit conference. And before that I actually had heard about it only from Dr. Nick Thompson who went to my residency. And when he told me he was opening up a DPC practice, I had no idea what it was.
But then this conference came across, so I thought I would check it out. So that was my mindset when I went to the conference.
Amazing. And publicly you've said that you were even contemplating leaving medicine. Before you went to the direct primary care summit. And so when we hear that from people like yourself, like other physicians what were you thinking were your options at that time?
Because how you're talking about this feeling of inadequacy because of us trying to, like a physician, trying to take care of patients the way we're trained to, without the infrastructure to do that. And the time to do that, what were you thinking in terms of, Okay, I might not be able to do medicine, I might be able to do xyz.
What were some of those thoughts?
I think. Feeling like I wanted to leave. A lot of it was not just feeling inadequate, but to the point of we are taking care of people's lives if I'm not able to do it while I want to get out before I hurt somebody. And so I thought about leaving medicine and I've always wanted to be a teacher, which I know in medicine we do teach, and the Latin word for doctor is teacher.
But I thought about teaching high school, college, I don't know what it was, but teaching was definitely on top of the
list. That's awesome. And it just makes me think of somebody like Dr. Erica Young, who was a teacher before she went into medicine. Now going from this place of, Dr. Thompson was in your residency, you went to the summit and then you came out of the summit.
What was the journey like immediately after you left the 2018 DPC Summit?
So I think I should share a little bit more detail about what happened at the conference. So I got there and immediately after the first session I was just so emotional and I texted Dr. Thompson, I said, This is amazing. I can't believe it's real.
And I just resonated so much with what even that first speaker talked about. And Dr. Thompson was like, Yep, just keep, keep listening, keep taking it all in. And during that, I think two and a half days conference, I felt like everything lined up in that it answered a lot of my fears.
And it also helped me see DPC was possible. And one of the panels I remember was a panel of three female physicians and one of them was Micropractice. So that helped me realize Micropractice was possible. And then people asked the, one of the common questions of how do you handle 24 7? And all three said they've opened for two or three years and they've only been called at night, maybe two or three times, something like that.
So, I think the conference reinforced a lot of the idea of when you bring the relationship back to the doctor and the patient, patients are going to be more. Respectful of your time as well. They want you to do well and they treat you more as a person and the doctors get a lot more joy. I remember one of the things they said towards the end of the conference was, You see so many of us looking happy because we are
And I think that just meant a lot to a doctor who was quote in the system and feeling like there's no way out and there's no joy in medicine anymore. Seeing them being able to say that gave me a lot of hope. And during this conference they also talked a lot about how DBC can help patients and help doctors be able to stay in medicine.
So a lot of things I said I felt like. Were the right things to get me hooked or have me bought in. And so I remember leaving the conference feeling truly terrified because I knew I needed to do this, but I also knew I had no business experience. But at the same time, I was just so encouraged to see so many people there and a lot of the resources.
So I felt like the pioneers have already done this for us. And I really, that's why I said the only thing keeping me from doing it is fear of running a business. I was in the best position in that I was single. My parents paid off my student loans. I had another question was how much to start the business.
And most people said 10 to 20,000. I had that saved up in my bank account. So I was like, really? There's not a lot of the obstacles are going to be taken care of. And so. Another thing leaving the conference was there were two quotes that kept coming into my head throughout those two and three days.
And one was what was attributed to Gandhi saying, Be the change you wish to see in the world. And so the more I felt like I believe in the DPC movement, then the next step is, well, are you gonna do it? And then the second quote that was in my mind was the idea if God is with you and is behind this and you can't fail, what would you do?
And so I just, that gave me a lot of peace about, Yep, you might, you need to do this. And then before I went to the car, as I mentioned the name Olive Branch came to mind because, So given all olive branch, as most people know, is to extend grace or reconciliation. And for me, leading up to that point, there's just so much contention between doctors and administration, primary care and specialists, doctors and patients, doctors and pharmacists and, whatever it is.
And I just felt like we really need to be able to give one other grace, but then we also, doctors need to give ourselves grace for quote unquote not doing a good job in the system that we have right now. And so I. From that conference, this was why I was so emotional leaving the conference because I just saw hope for myself, but also for other doctors and for patients as well.
So writing on all that I think was what gave me a lot of momentum , but practically after the conference I was added into the DPC Doc Facebook group and I bought and read Dr. Vagos Official Guide to Starting Your Own Direct Primary Care Practice. I think that was the only book that was available at that time.
And then I also got Dr. Julie Gunther's timeline on how to start your own DPC practice, which she has now incorporated into her book Sparks Start Fires, which I highly recommend. And the other thing was from Atlas md, kind of the resources and timeline as well. I believe so. Getting connected with these resources.
I watched a lot of the YouTube videos of past DPC Summit and Nuts and Bolt conferences. And then I also used the DPC Frontier Mapper to find out. There were actually two DPC doctors in St. Louis, Missouri, where I am. And so I visited Dr. Andrea Otto, and I contacted Dr. Rob Hicks and both of them gave me a lot of practical details on, this is the site I use to get my logo.
This is the this is what I used for my EMR and things like that. And then from there I did a lot. Just calculation to make sure I can live for a year, even if I don't have any income for a whole year. So trying to make sure I have enough savings to cover for my personal expenses and business expense for at least a year.
And then after that so the conference was, I believe July and all this thinking and planning. I was still very unsure, but around October I was visiting my parents and they were hearing me complain about the system probably the end time. And so they said, Well, why don't you go somewhere else?
And I said, It's the same everywhere else that you're employed. And I'm speaking from experience, so I actually have this other idea. And any listener who is of East Asian descent would know that it's very hard or unlikely for our parents to take on uncertainty. Like, sure, why don't you quit your job as an employee doctor and potentially not have income for a whole year.
But amazingly, maybe it because I complain so much, my parents actually said, Yeah, that's a great idea, you should try it . So I take it as a godsend that this open doors and encouragement to pursue it. So that was kind of the initial momentum and planning right after the conference. And then I think I still thought about it by the following year February.
First or third, whatever that Friday was. That was when I gave my notice. And until I gave my notice, I felt like I was still able to waffle. But once I gave my notice, that was it. It's, there's no going back. So, yeah, for anybody contemplating it, just know that once you give your notice, it pushes you forward a lot more because you've actually kind of spoken it into reality.
So I'm here laughing because, being Filipino it makes me think of that, that the same laughter that I had when Mike Chang got a B in glee and everyone was called, the episode was called an Asian f Like that, that is, it just makes me cringe physically when, like picturing you talk to your parents, but I am so glad that it ended up being that, you figured out what would work for you and you decided to open your own micropractice.
So when you went from this place of leaving the summit having that fear and deciding, what else am I gonna do? Did you create a business plan and at what point did you do that?
I think it wasn't anything official, but it was just part of that calculation of how much might be needed and looking at all the resources that were available from Atlas or from the dpc.group.
Um, This is coming from somebody who didn't have business background, so it was very much piecemealed. I think one thing I got right was I needed to open a separate business account. , and I think the first step is just start to register for an llc. And so I think I was following the checklist and so not really an official plan.
The first time I had to come up with a business plan was when I was applying for the business permit. But even then, I think Dr. Otto and Dr. Hicks both told me it's simple. It's just a one page thing. And I think I got away with it because I am micropractice so I don't have to talk about staffing or osha, regulations and things like that.
So my business plan was very simple. My mission statement or vision was really just to be able to take care of patients. And then I think my calculation was I aimed at 400 patients as my initial goal, and I figured possibly aiming for $50 per member per month, that should give me a comfortable salary if I keep my overhead low.
And I would say, That was what was needed to help me feel like this is doable. But later on as I actually opened, those numbers kept changing. And so , that's also a learning experience. But I think what helped me was just trying to keep things simple and not try to do too much too quickly. And then also I think for me, I def there was a lot of prayer involved and so I do believe God was leading me one step at a time.
So without a very good concrete plan, somehow one step at a time, I was able to get things done. And.
Thank you for sharing that, especially with the, the transparency in regards to you have, an ideal overhead and then it's like it keeps creeping up a little bit.
And one of the things I wanna highlight from a resource that you mentioned, Dr. Julie Gunther's, Sparks Start Fire's book. She mentions like, a I think it's 30% to whatever you think you're gonna charge because of pricing going up and now with inflation the, this is the time to think about.
What you need to be able to take good care of the people you want to take care of, and hearing your words is really inspiring in that endeavor. So it's awesome. Now, in terms of going from this place of you're praying, you are doing, you are believing, you're actively, you're going into taking patients and accepting patients.
So going from this place of fear and not knowing how to open a business and then actively doing it, whether you know it was comfortable or not. Believing that, you had God behind you, that you had done at least some planning which some people don't even have the time to do. And then going into the act of opening your clinic, you have a clinic space and then you have your first patients.
And so how did that two weeks or how did it go finding your space and what was the first few months like in your practice?
Finding the space was definitely a challenge and new experience. I looked online for potential office space and then actually found out retail space. I was looking for because I wanted to have easy access for wheelchairs or parking.
Knowing on Micropractice, I wanted to be somewhat visible, so not tuck away somewhere in the building where if somebody kidnaps me, nobody knows. so it took some finding, but the one place I found, and this is kind of neat, I think was the first place that. Actually leased in the end when I went to visit the next door business neighbor came out and said, Oh, are we getting a new neighbor?
And asked me about what I did. And he said, Oh, that's great. We're a collection agency, so if your patients don't pay you , you know who to call. But he was just really friendly and he reassured me that the landlord was somebody trustworthy and he's been there for 10 years. And so that was just a really good vibe and reassuring that this is a good idea.
And so I found my space. I Had to learn how to do or how to get business policy for insurance. And then also I had a friend who recommended a lawyer whose wife is a doctor and has opened a clinic before. So he was just out of his, the kindness of his heart. He was sharing with me some of the ups and downs that they had, and he offered to help me with my paperwork like contract and the HIPAA privacy notice.
And even just different types of common paperwork we might need for patients. So. Again, Dr. Otto was really kind in sharing with me her contract and said, Here, edit it however you need to. So I changed it to my name, to my clinic's name, and then shared with the lawyer and then he said let me just change it so it looks nicer to a lawyer's eye.
So he did that for me. So that's how I got the paperwork I needed to see patients. And then when I first started Dr. Otto again connected me with somebody who was selling an exam table and the wall mount for the VO Allen instruments and a few other things for just $1,500. It was a great deal.
So I had a lot of the basic things I needed. Right before I opened, my friends from church actually came and helped me paint the walls. And so it really felt like a community project to some degree. But the first day I opened, I had folding chairs in the exam room because I , I wanted to be able to find chairs that are sturdy enough for some of my patients who are heavier.
But my first patient was actually a Ben Medical student. And so he was very kind and said he didn't care about the folding chair. He was here to see me. And that was just very encouraging, reminder that patients are coming to you to see you and it's nice to have good decor, but that's not what ultimately seeing a doctor is about.
So. that was how I started. I didn't have everything together, but I think as I opened and started seeing patients, then I learned, Oh yeah, I need a kids' height chart on the wall. And so I got one from Amazon and spent an afternoon putting up the decal on the wall. And so this is also an encouragement to people that you get the basics, but it's okay if you find out that, Oh, you're short of this or that.
And just kind of put things together as you grow. And I remember when I first thought about opening this as I was planning, my then boyfriend, who is now my husband actually asked me, I think you should probably take another year to plan because cuz he knows I'm not a fast planner. And so he said, Do you want to hit the ground running or crawling? And I said, Crawling . And he was like, What? But I knew that I wanted to be able to have time. I knew that I wanted to take things slowly so I can improve with the process. And so, thankfully that's what I had hope for and that's how it happened, and that's what I needed.
I also knew I didn't want to do moonlighting again because I feel like I could only focus on starting the clinic. So that's also partly why I made sure I had enough savings for a year so I didn't have to moonlight the first year. So those were some of the consider.
And within that first year, you and your then boyfriend got married.
And so how was that journey planning, actively having your wedding all of those things be while being a DPC doctor because there's people along, their journeys or at different points having kids, preparing to have kids, getting married, all of the things. So how did you handle the wrapping in having a husband join the whole picture to your journey?
DPC actually allowed me more time to plan my wedding , so that was a huge blessing. And then unfortunately, The pandemic happened, but fortunately for me in a way that we changed it to a micro wedding. And so we were able to stream it to friends and family from, across the country and even on the other side of the globe.
So, it all worked out very well in a sense given the circumstance. And I do think that it was a huge blessing to have a dpc. So in that first year planning the wedding was one thing, and then being able to have the time to really learn about. What flow look like for me? Like what do I do with the first patient visit, and then what do I do with taking on phone calls or scheduling and things like that so everybody is going to do it differently.
But for that first year, I definitely have the extra time to be able to figure things out, learn from my mistakes, ask for help. And so I really treasured that first year that even though it was a little slower in terms of taking on new patients, but it was the rate that I had hope for or at least appreciate.
Those words speak to my heart because of, feeling I'm at the very beginning of my second year. And to you just even look back on the past year. I mean, you, you grow so much as an individual, as a business owner, as a physician, because of, those things, especially your workflows. Because the workflows are not just, how do you set up a laceration kit tray or, you know, it, it's, how do you do all of the things, like you saying, you're saying, answer the phones, do all the things.
So when you mentioned Dr. Otto I had the privilege of meeting her in Washington, DC this summer. And I will tell, like you and the audience. She slayed, workflows because what she did, and I think it was a genius thing, a genius move, was that she would go to the fmx lectures, whip out her laptop.
And as you know, I remember her telling me as they were giving her updates on , what to do with liver enzyme elevation. She was changing her macros live time because she said, and I hope that she shares herself on the podcast. She said that, she's not gonna go back and listen to the lectures or look at the slides.
So it's like, live time, I'm gonna change my macros. Now. Done . Then she was able to put them into practice right away. So, I just have to drop that because workflows absolutely make, especially in micropractice easier to do, I feel. And in terms of if you get to function at a higher level where your training is at.
So for you, in terms of. You're mentioning this first year, growing slowly, purposefully so that you could get the pattern down that you want, that you wanted to. What were some of the workflows that were really helpful going into your second year and third year?
I would say
I'm still learning. I'm not the most efficient egg in the basket . I think a lot of it is needing to unlearn some of the patterns that we picked up from the fee for service system. And so I think one of the thing is just learning how to document less or more efficiently. And then still, I think at one point still realizing.
The documentation is for other doctors too, in a sense because when I refer patients, I have to pull my visit and share it with them. So it's kind of awkward to still mention their cats or their vacation to The Bahamas or something like that. So I needed to learn how to trim down my actual notes and learn how to put those personal details that I wanted to remember somewhere in a invisible space on the chart.
And then I think the other thing is using templates a little bit more, I'm learning to use, for example, I use Atlas md and so I, created a routine physical questionnaire that I would send out to patients before they're physical so they can have a chance to update things. I am starting to use.
Scheduled follow up emails. So if I talk to a patient and we change medication, and I would even tell them, I'm going to give you a scheduled email in a week or two weeks, and then I'll send that out. So then even if I forgot by that time that email is out asking patient how they're doing with the new medication or did they call to make that cardiology appointment or whatever it is.
So, those couple things have been helpful. And then the other thing, maybe not so much workflow, but kind of in terms of setting better boundaries for myself. So if it's non-urgent text or calls, then I try not to answer outside of office hours. That's somewhat related to workflow, because that's learning about when to check messages and when to ignore.
And recently I learned from others that I could respond to the emails, but then schedule it to send out the next day so it looks like I'm sending out next day during office hours. So these are some of the little tricks that Ive found helpful so far. Love all
of those, the future self thanking your past self tips and tricks.
it definitely makes a difference in terms of you get to check things off your box without having to keep it on the perpetual to-do list. So super helpful. Now in terms of you mentioning, the accessibility part of your practice on your website, I just wanna highlight on your website it reads, you can always reach me by email, text, or phone for truly urgent issues. As long as I'm available, I will try to see you at the clinic the same day, next day, or outside of office hours. So I think that is awesome. I just wanna say that because it's not saying I am going to be there 24 7, 365, guaranteed a hundred percent.
because stuff happens, clearly we are human beings and stuff happens. But it also goes back to you hearing about one of your fears, taking care of patients 24 7. So for you you shared how those three physicians were sharing that they, you had only gotten a few calls. How has that experience been for you, given that this is your availability statement on your website?
So far it's been. Fairly good. I would say on average I've been open a little bit over three years now. I've definitely been called more than three times after hours, but I would say rarely, truly in the middle of the night, like one or 2:00 AM So overall it's been okay. Sometimes it's more annoying like the Saturday text about refill requests that they could have sent out a day before.
But I think there is still a difference and I think most people who have been in a call group would appreciate that. Usually when you get a call from your own patient, it is different from being called from somebody else's patients you don't know as well because you don't know the history. It's just a lot more mental work.
So for the most part even when I get texted or called later in the evening or over the weekend most.
Of the time, I might feel grumpy in my heart, but I would still take care of it because it is patients that I know and patients I want to do better. And I, it's better for me to find out now rather than later on when things get outta hand. So, I would say I've been texted or called a little bit more than I had expected, but not terrible.
Like most weekends I'm, able to enjoy my life and most patients are very respectful of that space. And if anybody ever, texted something that's not urgent on a weekend, I would. Try to take care of it if it's something I can take care of. Or I might say, Let's make an appointment and set up an appointment for the next week, or something like that.
And that's something that I've learned from other DPC doctors, that's partly how we try to help teach patients how to use the system, I guess. So if they're outside of the appropriate range, then just be courteous, but short in the response. And then when they reach out during the regular hours, then be more attentive to help them realize this is the right channel of reaching your doctor.
One of the things that I try to do is at the first visit, I, when I go over the patient agreement, I Would highlight that point about how they can reach me in about after hour policies. And then I would half jokingly, but half seriously say, just for my sanity, I'm the only person here, so help me make, do this long term.
Please keep non-urgent things too within business hours. And most patients will laugh and they'll say, Oh, of course. And so . But you know, just because the accessibility and the way that we're so comfortable with texting, I understand. I would also tell patients that I understand sometimes people just accidentally text because it's so available and easy.
So I would give them the example. I had a patient who accidentally texted me at 2:00 AM asking, Is our upcoming appointment virtual or in person? . And then when he, So I did not respond to that text till the next day, but He felt horrified that he texted me. And then when he saw me, he apologized profusely and said, I'm so sorry.
I just woke up and thought of it and texted and then realized the time. And so it happens. But I know that sounds terrible, but I think in the moment I was okay because again, I know this patient, I know that he didn't mean to, He's not somebody who is a regular offender at breaking boundaries and things like that.
So it was all good ,
and I think that, I appreciate that vulnerability also, just because that's live time and like your explaining what happened and what your thoughts were, how you processed it, I think it also reflects on your blog. And I really wanna highlight that because if you look at your blog it literally is your journey and little snapshots, even your folding chairs there, But I love that.
Ima I can only just imagine how this is how you talk to your patients and how you're just like, Yeah, like I, I need to tell you the things I need to tell you and I wanna answer the questions that you have, and now have the time to do that. So I love that. And I wanna now highlight another part of your website.
On the very front page of the background is the arch in St. Louis. And then you have a paragraph, and I, I think it's awesome. Like, my website's very different, but I thought that it, again, it just, it goes with what you said, the spirit that you have, your blog and how you've documented your journey.
It's a mission statement so, when you described writing your vision statement for business purposes, was the statement that you had on your homepage, what you had as your vision statement as well?
Or did you write this copy specifically for patients as if you were talking with them as if, as they're thinking about joining your practice?
The background for my website was I made the website while I was still employed. And so that was kind of a space for me to be able to direct patients to if they were interested in the dpc.
But at that time I had no space. I didn't know where I was going. And so I think because DPC was so unfamiliar to most people That was also just an opportunity for me to explain a little bit about what Direct Primary Care was. That was the, in initial intention of the website, is to help people know what this model is, but then also share why I was doing this.
Because I think a lot of doctors would struggle with this sense of guilt of abandoning their patients when they leave the practice to go start a clinic on their own that doesn't take insurance. And so I think a lot of what I put on my website, that front page, was actually probably a lot of my own processing as well.
And so I. Because I didn't have a space and because that was more of an update for prospective patients who had told me they were interested. That's where the blog clinic news section came about as I was trying to tell them when I was going to have a space and how that's going. And so I think this is why my website is kind of a mix of unofficial clinic site versus personal blog.
I'm not sure what it was, but that's the beauty of DPC is that it doesn't have to be a perfectly neat professional clinic website. I think two years into my dpc, one of my former patients came and found me again, and one of the first things at the informational session, He said was, Well, actually his wife asked me about questions and about the model, and then when it was his term, he just said, No, I have no question, but Dr.
Lou, you website. And I was like, I know it needs updating . And he was like, Yeah, , but that's okay. We're still coming. Anyway. So, so yeah, I would say the front page of the website, my story was to share with patients kind of how I came about I guess. Not really intentionally to make it a mission statement, but I think it was just more where I was coming from.
And that's one thing I appreciate about DPC, is it allows me to really practice out of who I am which I had been when I was at the employed system, but it's just a lot harder when I couldn't spend that time with patients to educate or talk or being able to listen very well and take care of the things that they wanted to take care of at that session.
So, that's kind of the explanation of how my website came about and the arch I moved to St. Louis in 2014, but I just really love the arch. And so I think I also put it there because I love that idea of the arch as like gateway to the West, like, start of the journey to the unknown or like new Frontier.
And so to me, at that time also, this is like. We're going to dpc. This is a new frontier for most people, but this is worth the change it's worth learning about. And I think that's how it all came together.
Awesome. And I think your website continues to reflect that, so I don't think it's outdated at all.
And one of the things too that you have listed on your website as your pricing, and so, in terms of new frontiers, I would say a new frontier for patients especially is to see things like if you're a hundred or over, it's a dollar a month for care with a physician, like your personal physician. So in terms of that new frontier, it's definitely something that physicians have done all over the nation and in their different communities. How has that turned out for you in terms of utilizers and in terms of care that you've been able to give for a dollar a month?
So I currently don't have anybody who is a hundred yet. I have one patient who is in her early nineties, so who she might be the first to get there. But I think that idea came about when I was looking at other practices, pricing. So it's, I definitely did not come up with that. But I love that idea of being able to offer that because as we know, end of life or as patients get older, they are using their savings or they have more medical expenses.
So for me that's a way of, I guess a gift of somebody who has lived for so long and it has endured so much that primary care access should not be another stressor on their plate. And so even though I don't have anybody who is that age yet to be able to utilize that discount, I guess, For my other patients who are even at the 30, 50 or $75 tiers, many of them have expressed that it's still a good price, I guess, or a good investment to be able to access their primary care doctor to have that many people say they have peace of mind, knowing that they can reach their doctor, they have a medical resource to turn to when they need it rather than being directed by central scheduling or triage or have their message be left on the online system for several days before reaching the doctor.
So I think most patients do appreciate being able to be taken care of at a affordable price.
Absolutely. And in terms of your panel, what is the percentage of your panel that has insurance and chooses to still pay because they value your value proposition?
Yeah
I actually did some calculation. About 60% of my patients have private insurance and I think about 6% with Medicaid and 6% with Medicare. And then I think it's about 18% that's truly uninsured. And the rest are one of the healthcare sharing organizations. So most of my patients still have insurance and that's what catches a lot of people by
surprise.
It's awesome. And like my practice, a hundred percent of my patients have insurance and they can't get in to see my husband. So , I'm like so I think that that is definitely something that this is why what Dr. Valesky said in his interview, he thinks that DPC can work anywhere. And I really truly believe that.
And definitely, if you're like any listeners having issues concerns, questions, there's a whole tribe of people like you and I that are accessible now because there are so many direct primary care and direct care clinics that are popping up just like, popcorn and a microwave.
So, this is awesome. And I will put one more tip in here. I actually had a patient who Was going to turn a hundred, like, this patient was 99 years old. And the, the, the tip that I wanna say is especially for people who are getting into that older age range, closer to the a hundred year plus age group, I definitely would say I encourage people to think about talking with the whole family and how the family can use the access to the doctor because in my case, it was a very.
Urgent based, Oh, we need you now. We need you now. And so I definitely would encourage people to have a frank discussion about this is the membership agreement, not only with the patient, but if they have somebody who is their dedicated healthcare advocate to have that discussion with them too and , allow them to also have the space to ask questions and hear the boundaries of your practice and what you're able to do and what you're not able to do.
Because we are, like, most of us do not also work in the hospital. Some of us do as direct primary care physicians. But I just wanted to add that 2 cents in there because I had not experienced that. And I'm another clinic who offers care for ages a hundred and over for a dollar. but I agree with you. It is so awesome to be able to say you have lived a hundred years. Like, absolutely what can I do to help?
Now you have said in the past that you love this idea of practice, how you ultimately want to practice. And so for you, now that you are your own clinic, like you, you operate and own your own medical clinic, your own direct primary care, how has that idea manifested in your care?
Thank you for that question. I can think of a lot of different ways that has came to fruition and that why I love direct primary care. So thinking about that older patient or even patients whose first language is not English. In the traditional practice or the typical practice, you only get 20 minutes, 30 minutes even with an interpreter.
So just imagine that, right? But so one thing is I'm actually able to take the time I need and not feel rushed with my patients who need more time. And I am able to get patients in most of the time within. The same day or the next day for something acute. And if I can't get them in many times I can take care of some initial things over the phone or do a video visit.
And so that's a huge contrast to in the past when patients may not get in for three weeks for something acute. And then the other thing is I love, I don't advertise this, but especially for pediatric patients, I love being able to offer to do home visits. As the first time that came about was both parents had to work couldn't take time off the next day to, take the child to me, but then I actually live closer to them than I was at my clinic at that time.
So I just say, Would it be okay with you if I just stop by after work and take a look? And they were just shocked that was even a possibility. And I just loved that surprise factor. But also for something so simple as looking into a child's ear, at their home um, So being able to do that and then being able to offer some, again, I don't advertise this yet, but being able to offer some Saturday morning clinics for patients who truly can't take time off work during the week.
When I was employed, they had thrown that idea out as a possibility, but in reality it was impossible because they could not get staff in to come in after hours or on Saturdays. And then that brings me to another example I love to share with people is that um, so there's a story of when one day in the winter sometime our clinic was canceled because there was a snowstorm.
So we heard about it at seven 30 in the morning. That clinic is canceled and because I lived in Iowa for 15 years, so I don't mind the snow, and I lived close enough to the clinic and it was more efficient for me to work at the clinic to try to catch up on paperwork. So I went to the clinic and. When I was there sitting there, eight o'clock came and I was thinking if my eight o'clock patient were to come, and I'm pretty sure it was something as simple as hypertension follow up visit.
I was there, she was there. We can definitely make this work except I can't because I didn't know how to check patients in, take their copay, all this, other things that I needed to do to logistically get her checked into the system. So DPC takes that all away. I can see patients whenever the patient shows up and I'm here , and so, for my patients who I know have to work late or whatever if I am available, then I could offer a five o'clock, six o'clock.
I purposely have my Thursdays at my as my evening clinic. So I start at four and go to 8:00 PM so that kind of flexibility is one of the things that make me feel like I'm more of a doctor than I was before in the sense that I can take care of the patients and I'm not restrained by all these external things that I have no control over.
it's just
beautiful. It's just so beautiful to hear that because going from a place of feeling inadequate, Of you wanting to be able to provide the care that you wanted, and again, just not being in a place that allowed you to do that. And I totally hear you on the, like, we have no staff, so I can't see you, but I can see you because I'm a doctor and I can think all the things I need to without you physically having to be here.
But that's not how the system works. You have to physically be in here and we can't have you come in. X, Y, and Z staff are here. You must be so proud of yourself and I'm so proud of you to hear you say that you're in a place where DVC just takes that all away.
I can see the patient when I want to. So when you look back now, because you're past your third anniversary, which is amazing and congratulations on that. Thank you. Yeah. Um, When, and expectedly people, I'm sure, just like you reached out to Dr.
Hicks and Dr. Otto and they reached out to you I'm sure people are reaching out to you to say, Hey, Dr. Lou, how are you doing this? How are you doing this? As a micro practitioner, how are you doing this? Three years out and going into your fourth year , how often do people reach out to you and how do you incorporate balancing people reaching out for advice or support with your patients and family life,
Thinking back, I've had different people reach out. But I guess it really hasn't taken up that much of my time. I'm trying to think. So when I reached out to Dr. Hicks and Dr. Otto, they were the two DPC doctors in St. Louis. And amazingly now, like four years since that time, we had a meeting with maybe 12 DPC doctors or 12 interested DPC doctors.
So it's definitely grown. And I guess oftentimes people. Look up dpc, probably from the mapper or just from others who know about one of us. And then gets our names passed around so then people would reach out and talk to us. And I think I do try to pay it forward and I'm happy to meet up with them and share any insights that I gained from other people in my own journey to to see what would be helpful.
I guess so far there hasn't been too bad of a balancing act since it's not like there's a doctor asking me every week about dpc. But. I, so I'm part of the St. Louis Academy of Family Physicians board. So, and interestingly, Dr. Otto and Dr. Clarissa Allen and Dr. Lauren Mitchell are all on the board.
So there is a strong DPC presence right now, . And so I think in that space, others hear about it. And then dr. Otto and I have gone and talked to the Family Medicine interest group to talk with medical students about what DPC is. I think. I have somehow got connected with one of the local family medicine residency, so that I've gone there three years in a row now to talk with the third years during their practice management rotation to give a short talk about dpc.
And also about the different settings that I worked with before, like locum tenens and urgent care and fqhc. So I think part of my work, I guess, is to try to help raise the awareness of DPC and whether that's being willing to talk to people patients and physicians alike about this, or trying to reach out to medical students and residents.
Just whenever I can. I guess that's how it's been happening. And I guess part of the, I do like to talk to people face to face. So maybe that's part of the balancing is that when people reach out, I would look at my schedule and see where I can reasonably meet them without stretching myself too much, and then go from there.
That's a great, response. And I'm sure that there are so many people in the audience who appreciate that because it is still, a statement of absolutely love the idea of paying it forward. And I also have to protect my own time so that I can continue to function just like you tell your patients, Help me help you.
So I, I love that. And so when you are talking to people in training or other physicians and you talk about success, how do you define success now that you are no longer an employed physician and you are your own boss?
So I try to give people a word of caution or caveat that I am only one DPC practice.
And I love passing on that quote. Once you've seen one DPC practice, you've seen one DPC practice. And I say that because I have intentionally decided to not moonlight or take on a side job. And so I let people know that I, my income is not where I would like to be. So don't let that scare you off into thinking DPC is not profitable or sustainable.
But that being said, I think my one measurement of success is that I have been getting more patients as each year goes by. But another measurement of success is just. The happiest I've been since I've been in training. Just being able to enjoy life and being able to enjoy being a doctor, being able to enjoy those patient interactions because I'm not stressed out by needing to check the box or getting them out the door by a certain time or, all that.
And so I would say the success is finding my work more meaningful, purposeful, and being able to enjoy that flexibility that comes with having my own clinic and being able to take care of my own schedule and being able to mentor doctors in training and students, and even being able to let high school students and college students shadow in a time where nobody is.
Able to take learners or shadowing during the pandemic. And so, I would remind myself all those are successes, especially when the reality of not having as much finances as I used to kicks in from time to time. but yeah, I think it's all putting things in perspective and being thankful for what I have, right.
And
Dr. Lou absolutely for the audience of ours is smiling so big. And this is why, just like you experienced at the summit, you're surrounded by people who either planning dpc, they're doing dpc, their, their seasoned DPC doctors , and happy is a very basement floor way to describe the feeling that you get when people like you and I are in the same room.
So with that, thank you so much Dr. Loop for joining us
today. Thank you so much for having me. Appreciate it.
Next week look forward to hearing from Dr. Matthew Mintz of Matthew Mintz, MD in Bethesda, Maryland. 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. It also helps others to find the podcast if you leave a five star view.
Podcast and on Spotify now as well. Thanks for helping spread the word about DPC in advance. If you're on social media, check us out on Instagram, Facebook, LinkedIn, YouTube, and other platforms. If you're wanting to continue learning more about DPC in the meantime, check out DPC news.com. Until next week, this is Marielle conception.
*Transcript generated by AI, so please forgive errors.