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Episode 110: Dr. Matthew Mintz (He/Him) of Matthew Mintz, MD - Bethesda, MD

Direct Primary Care Doctor


Dr. Mintz in a white coat
Dr. Matthew Mintz, MD

Board-certified internist Matthew Mintz, MD, FACP, practicing in Bethesda, Maryland, provides old-fashioned, personalized care with today’s advanced diagnostic procedures and treatments. He serves patients in the cities surrounding Bethesda, including Potomac, Rockville, Chevy Chase, and the larger Washington D.C., Maryland, and Virginia areas.


Named one of Washingtonian Magazine's Top Docs since 2012, Dr. Mintz received his medical degree from George Washington University School of Medicine in Washington, D.C. After 20 years practicing medicine and teaching as a full-time faculty member at George Washington University, Dr. Mintz decided to open his own practice in Bethesda. Dr. Mintz is affiliated with and has privileges at George Washington University Hospital in Washington, D.C. and Suburban Hospital in Bethesda.

He has researched and published articles on chronic diseases such as diabetes, asthma, chronic obstructive pulmonary disease (COPD), and obesity, and he is active as an educator and personality for local media. Dr. Mintz continues to serve as Clinical Associate Professor, teaching at the medical school and having George Washington medical students learn in his office.


Dr. Mintz emphasizes traditional healthcare values, where every patient is a person, and not simply a case. Dr. Mintz restores the idea of the personal care physician, who has a relationship with each patient, removing the frustration that often accompanies contemporary healthcare.

Dr. Mintz grew up in Montgomery County, Maryland, and graduated from Churchill High School. He currently lives in Rockville, Maryland with his wife and two teenage daughters.

 

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Transcript*



So I'm excited to be on this podcast because I love dpc. It allows me to practice in ways I never thought I could. But more importantly, I really wanna share this with younger doctors. I'm sort of older and at the end of my career, but really help to help other doctors discover this new way and help them sort of create the practice, that they could have never imagined. I'm Dr. Matthew Mintz. I'm an internal medicine primary care physician in Bethesda, Maryland. And this is my DPC story.




 Dr. Matthew Mintz is a board certified internist. He practices in Bethesda Maryland and provides old fashioned personalized care with today's advanced diagnostic procedures and treatments. He serves patients in the city surrounding Bethesda, including Potomac, Rockville, Chevy Chase, and the larger Washington DC, Maryland, and Virginia areas named one of Washingtonian Magazine's top Docs.


Since 2012, Dr. Mince received his medical degree from George Washington University School of Medicine in Washington, dc After 20 years practicing medicine and teaching as a full-time faculty member at George Washington Univers. Dr. Mince decided to open his own practice in Bethesda. Dr. Mince is affiliated with and has privileges at George Washington University Hospital in Washington, DC and Suburban hospital in Bethesda.


He has researched and published articles on chronic diseases such as asthma, diabetes, c o P. D and obesity. He is an active educator and personality for local media as well. Dr. Minz continues to serve as clinical associate professor teaching at the medical school and having George Washington medical students learn in his office.


Dr. Minz emphasizes traditional healthcare values where every patient is a person and not simply a. Dr. Mince restores the idea of the personal care physician who has a relationship with each patient, removing the frustration that often accompanies contemporary healthcare. Dr. Mince grew up in Montgomery County, Maryland, and graduated from Churchill High School.


He currently lives in Rockville, Maryland with his wife and two teenage daughters.


 Welcome to the podcast, Dr.


Mince. Thank you. It's great to be here. ] going back to your opening statement, I know that you are definitely a few steps ahead in terms of your training and your practice years, but I will say, I hope you're not at the end of your journey just because you have such an amazing story and all of the things you've continued to achieve past your life and fee for service.


I think it's amazing. And so I, I just wanna drop that there as we. Thank you. I appreciate that. No, I've definitely got a, a few more years to this. I, I don't plan on retiring anytime soon, but I definitely, this is something that, I did late in my career. Had I done it earlier, I probably would've done things a little bit differently.


But no, most people, at 50 years old don't just like start a new practice. So it's a little bit unique. I'm gonna guess that if Dr. Tom White is listening to your episode today, he's like, Yes, you go so well. Now with that, with you mentioning how you are very passionate about educating and inspiring the next generation of DPC doctors and the generation after them, I wanna ask you, looking back to your life after residency, what did that look like for you in terms of what was on the horizon?


Private practice, group practice only? What did it look. Well, actually that's really a good place to start because it sort of, it explains sort of how I got where I was for, up until this point. Because, I knew that I loved primary care. I had dabbled with the idea of maybe doing specialty medicine, but I really just like too many things.


I did my medical school at George Washington University. I'm from the Maryland suburbs, wanted to stay local for medical school, and GW was one of the few programs that actually had a primary care residency, so it was internal medicine, primary care residency back. A million years ago, most internal medicine training was all inpatient.


You got very little outpatient training. And so there were some primary care internal medicine residencies that had developed. Fast forward, things have changed. You haven't seen new primary care programs. What you've seen is the categorical medicine residencies have just adopted and now they're doing more like 50% outpatient.


But at the time it was really unique. So I stayed, did my residency at GW in primary care, internal medicine and wasn't exactly sure this is at you know, the end of the, nineties where, there was a lot of upheaval. People were talking about managed care and the PCP was gonna be the gatekeeper and it was gonna be all different.


I was a little bit skeptical. I wasn't sure what I wanted to do, and they asked me to be chief resident and, for medicine chief residents, an extra. And to me that was a good stalling technique cuz I really didn't know what I wanted to do. And sometime during my senior residency, you know, chief residency decided I really like this academic stuff, I really like this teaching stuff, I like this environment.


And so I stayed on his faculty after chief resident for 20 years. And so I was full-time academic for 20 years at the George Washington University. And I did a lot of different things. One of the, I actually was started, I thought I was gonna do clinical research, but a lot of things happened and I wound up in education very, very early.


And so I did a number of things while I was there. I was the primary care clerkship director for about a decade. I got involved in our clinical skills course. We had a um, problem based learning component of our clinical skills course. So I directed that for a number of years. Then I took over the entire clinical skills course for a number of.


And then about several years before I left, the dean of the medical school asked me to come over to the medical school as dean to basically lead our curricular revision. So the last four, so years that I was there, I was actually in the dean's office doing mostly, medical school curriculum stuff.


So So I guess I got scared of what the real world was. Ended up academics and really had a very sort of, 20 year academic run being very involved in academic medicine. And I, again, though, I can really see how you're so passionate about continuing to inspire the next generation, in this case of of physicians practicing in the direct primary care model because you have such a strong history already of inspiring so many primary care physicians.


So I absolutely love that. Now one of the things that you have mentioned publicly is that you came to a point where you realized that, it was really challenging to foresee , your family, continuing to survive on the salary that you were being paid.


And so I wanna ask, how did it come to that place and how did you start realizing this might not be my my forever job. Hmm. Right. So in my mind it was my dream job cuz I loved what I did. I got to do research, I got to take care of very interesting patients. I got to work with students, got to work with residents, I got to teach.


And then later on I got to develop curriculum. I loved my job. I planned on being there forever. I thought it was my forever job. But there were two things that made that very difficult. The one was I dealt with, but it was hard. It was the commute. So I live in the suburbs of Maryland and my, practice was in DC and uh, Washington DC traffic is, is pretty bad.


And sort of the one hour plus commute each way for 20. Was, was starting to take its toll on me. So, but I probably could have lived with that for a little while longer. but really it was just a salary. I mean, no one goes into primary care because they wanna make a lot of money. Okay. We realize that, But I, you know, I grew up and now live in the suburbs of Washington, DC and I never thought in a million years that I couldn't be a doctor and raise my family living in those suburbs.


And again, I don't wanna imply that I was living in poverty. We took a vacation every once in a while. I mean, I was able to keep my family fed, but, we went to public schools, didn't have any fancy cars, didn't go out to dinner. It was, it was hard on a primary care physician salary.


Now, one of the things about academics is, the, the most underpaid, professionals other than primary care physicians or teachers, so primary care physicians don't get a lot of. Teachers or academics don't get a lot of money, and that intersection is pretty poor. And then you add the, living in an area that's a relatively high cost of living, a suburb of a major metropolitan area.


The economics of that just didn't work out. So, I would've been happy if I could have met and made ends meet. I would've been happy, but it just wasn't working out. So I was ready to leave. About 10 years into my 20 year career, I was ready to leave. I went to my boss, the chair of medicine, and said, I can't do this anymore.


I'm, I'm getting in debt. I I can't do this anymore. And my boss came up with the idea of starting a concierge practice. And so, our, our medical school, our medical institution is not the only one to have ever had a concierge practice, but it was pretty unique. And again, I didn't wanna do concierge medicine that was for like, rich people and I don't wanna see that.


But the, I was literally ready to leave and, and the alternative, starting my own practice without any business experience, this was before I even knew what DPC was, you know, was very daunting and I wasn't gonna be able to teach. And here I basically can keep the job that I love, have an increased salary so that I can stay here for hopefully, And, you know, I'll try this concierge thing.


So it was a really no brainer because ultimately I wanted to stay at the job I love. The problem was, is that while the salary we agreed on was enough to keep me there, it wasn't enough to keep me there to stay. Cuz the idea was the salary would go up over time. But unfortunately that did not happen. So that's why I ended up having to leave ultimately, despite being a concierge doctor and despite being dean of a medical school, I was still making less than the average primary care physician across the country.


And I think one day, you know, when my daughter was applying to these colleges and I was looking to where she wanted to go she wants to be on Broadway. And so, we don't have to talk a lot about that, but basically if you wanna be on Broadway, you have to go to one of these colleges that have a musical theater program.


It can't just have a good music program or a great theater program, it has to have a good musical theater program. And so my state school. Didn't have one. And GW, where I would've gotten the faculty tuition benefit, didn't have one. And so I realized that I can't send my kids to where she wants to go to school if I continue to stay.


And ultimately that's what happened. That's why I ended up saying I can't, you know, it was a good 20 year run. I love my job, I hate my commute, but I love my people. I love my job, but I just can't stay here, if I wanna sort of survive long term. And that's ultimately why I decided that I had to leave.


And it's so relatable and especially when you said, like if they had just done this, I might have stayed. I can relate to that completely. Yeah, and, and I think one of the differences in my story is that one, I guess I learned early on that that not only did I like the teaching, but one of the things that was good about teaching is it balanced my schedule. So, you know, my, while early on , I saw a lot of patience.


Pretty early in my career I was 50% or. Clinical. And so while, yes, I saw lots of patients, some of my clinics were resident clinics, so the actual clinic time, while I had that typical burden of the primary care physician, seeing all these patients and doing all the charting and the EMR and the stuff that people.


Don't like That was actually, for a lot of the time that I was there, a small part. So to me the clinical stuff wasn't that bad. I wasn't really complaining about it cuz I had so many of these other things that I was doing. And so, you know, what was interesting about the concierge is that I didn't wanna do the concierge.


That wasn't anything I was thinking about. it was, to me it was about I can't, I love this job, I can't afford to stay. This was an opportunity to stay. But what was really interesting is when I started the concierge practice, I learned the value of time that I got to see patients, when they needed to be seen.


I got to spend more time with patients and what I recognized was that I was delivering better care. It wasn't that I was such a good doctor or better than any of my colleagues at the academic institution. It was that I had time to spend with my patients. I didn't have to refer them. If they needed to me, I could see them or, or, or work with them and maybe keep them out of the emergency room.


And I just, realized not only was this more fun, like getting to know patients and having that relationship with them, but it was, I was delivering better care. And so that was the angst was, well, you're just gonna be a concierge doctor and, and only the rich people can see you.


And so, But wait, but here's the thing is that is doing 15 minute visits, complex primary care and 15 minute visits, is that could also. Because, Because I know that my colleagues are all very good and they're doing the best they can, but you cannot deliver complex primary care in 15 minutes.


You can't do a good job. So everyone who's still on the insurance treadmill, they're doing the best they can, but that's not the same thing as good care. And so, was one of the things, again, cuz I went into concierge reluctantly, but I realized, wait a second, this is much better. This is a much better way to deliver care and, and get good clinical outcomes.


And it's more fun and it's more relaxing and you're not as stressed, but this was just a better way to do it. And so that's sort of what I learned the last several years that I was there, that this was a much better. And going into the way that the concierge model was set up through your academic position, how did that work technically in terms of , was any part of your salary impacted by number of patients seen per day?


And how was the, the clinic run in terms of, did you have a set number of patients as your maximum number on your panel? Could you give us some more details about how concierge medicine works when an academic center is involved as well? Yes, that's very interesting. And so, again, I don't know the numbers of academic centers who do this.


My guess it's a small number, but what was interesting, so on the one hand where my boss said, Yes, let's have you do a concierge practice. They didn't tell me what to do and how to do it, which has its pros and cons. So we agreed on a salary. Okay, so the idea was, is that if I wanted my salary to go up, I would have to see more patients.


I would have to get more patients to my panel. They did not do anything at all to help market the practice. They sent out one mailing and that was it. So I was all on my own as far as. You know, Marketing, developing the model, et cetera, et cetera. They really, they allowed me to do it, but they didn't really put any money into it.


In fact, there was a lot of sort of, um, things that came with the deal. So, for example, one of the things they had already been doing is executive physicals, and they were having challenges with that. So part of the deal that I made was I would take over the executive physicals until I was able to generate enough revenue.


My goal was to eliminate that because I didn't like the executive. The, I don't think that model is a good model for a variety of reasons. So my hope was, is to eventually eliminate that. But because I didn't get a lot of support to grow the practice, I wasn't able to do that. And then one of the things that I figured out while I was there through just talking to people is that.


The other need that we had was international care. So what I ended up doing actually, because there was patients, is I started international clinic as well. So I had my concierge practice, I had the executive physicals that I was doing and I started international medicine practice. All with the goal of sort of trying to build, generate enough revenue so that eventually I could increase my salary but also get rid of the executive physicals cuz, whereas the concierge thing I thought was, this is the way everyone should have, everyone should have a concierge doctor or a DPC doctor, whatever.


That's the way it should be. But the executive physicals I did not like at all. we were contractually obligated to offer 40 year olds colonoscopies and I ended up, tying well I had to do that contractually, I ended. Talking out a number of 40 year olds out of their colonoscopy that they were, you know, offered.


I did not like to be executive physical, so, eventually the goal was to try to, build up these practices so that I could, eventually get the salary that would keep me there. And then what happened was the dean asked me to come over to the medical school to revise the curriculum and so I gave up the executive physical, they could let someone else do that.


I gave up the international practice, they could let someone else do that. And I basically kept my small panel of concierge patients while I was deans. The last few years that I was there, I was basically 80% dean and then I would run over to the clinic any one time, one of my concierge patients needed to be seen.


Gotcha. And just for clarity, when you say executive physical, what does that mean? Generally? So this is a model that is usually seen as a corporate perk. So the idea is you're a busy CEO or top, C-suite executive. You're busy so you don't have time to see the doctor. Okay? But you're also a, a big value to the company that you work for because replacing you if you get sick and die would be very extensive.


So a lot of companies will offer these executive physicals. It's not primary care and that's the, the problem, but it's sort of a, you go to the doctor, you spend a day or a half a day there and get everything done in one shot. You do all your screenings, vision screening, hearing screenings pulmonary function tests, cardiovascular treating like stress tests mammograms, colonoscopies.


It's sort of a everything in one shot deal. Talking about, sort of all your care in sort of one. And, you know, it's a pretty high price and, they pay for that. And so, prior to me coming or prior to me, doing this our institution had started one of these executive physical type clinics.


And again, we're not the only academic institution that does this. And actually it didn't work out well except for one contract that we had. And so that was going okay. And so they asked me to take over that. And while I didn't hate it, these young executives were, you know, nice to talk to and interesting.


I didn't feel like I was doing good medicine. I was doing, more than needed to be done. I mean, again, I'm academic, so I'm trained on evidence-based medicine and we don't do tests unless they need to be done or there's value and proof. And this was sort of the opposite of what my training was.


And while it wasn't unpleasant, I just, it wasn't the kind of medicine that I wanted to practice. Yeah. And as you're, explaining the, overview of an executive physical as you're talking about, like the importance of the, the person, if they didn't show up to work, I'm like, well, that's every human being who works in America.


So that's funny, that direct primary care to me as you're saying that, I'm like, you're going through pulmonary function tests like all these things and labs, if they're need, I'm like, Oh yeah, that's what all of us do for all of our patients as they're needed. So I, I love that bridge between you finding out, your place in medicine where you wanted to be able to practice the way you wanted to practice balance the, not having to worry about the finances on top of being treated and valued, a as you should be as a physician.


So, I wanna go into, when you were doing concierge medicine, realize the value of time. Did you know that you were, leaning into the tenants of direct primary care? Or had you learned about direct primary care at that time? Good question. So, So again, it was about plus or minus halfway through my career.


So 10 of the 20 years. I knew that from a, this is again before my kid was going to college, but I just knew that I was not making enough to support my family, say for retirement, et cetera. And I knew that they couldn't pay me anymore. So I was starting, before I went to my boss to say that I was leaving, I started looking, sort of getting a lay of the land.


And so I met with a number of different, Because I knew that I was gonna do private practice. , And even then I knew that insurance based medicine probably wasn't gonna work. Cause I realized that that was why my salary was so low. So I met with a lot of people and I looked at a lot of different models, and DPC was, maybe it had a name back then, but it was not really there.


And so I met with a number of people that were, doing, either concierge and again, not necessarily what I, you know, when I think of concierge, I think of corporate concierge, like M D V I P and things like that. I wasn't talking like that. I was talking to some of the early pioneers that were sort of out there and doing it, and they did it in various different ways and just to see if this was viable.


So, for example um, there were some older doctors who I don't even know if they call themselves concierge doctors, but basically what they did is they did what I call cash fee for service. So, in other words, they. They didn't take insurance. But when you got, when you were seen, you paid cash and they would give an invoice and you could submit that to, insurance, but they didn't bill insurance.


And what they did was, is that that physical. They just charged a lot for that. So the physical was sort of a mini concierge and that's how they did it. I talked to one of the very earliest pioneers who I think is just retiring and trying to look for someone to get his practice is Alan Din who was his clinic was called Doc Talker.


And he did it in a way that I don't think anyone has ever done. And that was really unique where he charged like a lawyer, he charged by the minute. So like the physical was X number of dollars cuz it was 60 minutes. And if you needed a prescription called in, he would charge you whatever his rate was like three minutes.


And you know, he was a real big pioneer out of the box thinker. And so I met with all these doctors. He was in Virginia. I I I sort of traveled and what I realized was that there, there were a lot of different models out there. No one had sort of figured it out. But this was something that I could.


And so the other thing that was interesting is because I had spent all this time researching, and I actually, I don't know if you, It's even online now cuz it was like 10 years old. But I actually wrote an article for medical economics cuz I had done all this research. I'm like, know, I might as well write an article on this cuz it doesn't exist.


And you know, I'm sure, someone like medical economics would publish it. And they did, all the different models of doing primary care out there. Cuz you know, cuz I, that article didn't exist for me, so why not write something? So I did that. They, I don't know if you, it's still available cuz , it's at least you we're talking like 15 years old now.


But, but I, so I was ready to go and I hadn't sort of figured out what my plan was. Am I gonna start a dpc? Am I gonna do cash fee for service? I just knew that the market was there, it was doable. Others had come before me. So I went to my boss and said, I'm leading without really a plan. And he came back with the concierge practice.


And so I never did that until 10 years later when I realized I couldn't stay. Now these days, you know, I, I feel that there are a lot more residents who are.


I'm gonna do DPC after residency, which I absolutely love. , when you look back on your journey in terms of your mindset to choose to practice on your own, you were pretty confident about, I know I need to do things a different way, and this is, I, I love this idea of having time with patients.


In terms of the mindset, when you were then building your ideal practice, what were your intentions and how did you achieve those? Because your transition to direct primary care was within days. So, can you, can you share a little bit about that part of your journey and your mindset there? So it's very interesting because again, the, the first time I thought about this and I went to my boss and said I was leaving and I had no plan.


So, so the second time around I was, I, my plan was, is, so the academic year goes from July to July, I was gonna try, I was now in the dean's office. I was gonna try to get my contract, you know, toward the end of the year to, be a reasonable salary that I could stay. And then, so that's in July.


So in late March, early April, I found , the group two of the doctors that I had talked to 10 years earlier were ready to sell their practice and they reached out to me because they wanted to sell their practice. This is in late March, early April. So months before I was, I was still thinking hopefully I can negotiate.


But they wanted to sell their practice and they wanted to sell it. Now, And I was like, I wasn't quite ready. I wasn't there yet, but like, this is too good of an opportunity to pass up. So I met with these doctors, they, they told me sort of how they operated. Again, they were cash fee for service.


They, I don't even know if they called themselves concierge, but they were essentially a concierge type model, but it was cash fee for service. It wasn't corporate. They were both sort of part-time and one of the partners had decided they were done, their lease was up and they wanted to unload this practice as soon as possible.


And so I met with them and I was so convinced that this was gonna work out, that I gave my 90 day notice. And so that was the plan I was gonna take over this practice and, basically, take it over. I'll use their model and, tweak it here and there. There was no overarching ideal plan.


And I work with these doctors for. 30 days looking at over their financials and stuff like that. And ultimately they wanted too much money. They wanted to sell their practice for too much money. I knew from my previous, research that I, I could start my practice. I, I would take out a loan or something like that, but they wanted to sell.


But. So they had hired a consultant who told them their practice was worth three quarters of a million dollars and wanted to sell me that for half price and thought they were giving me an incredible deal. And I'm like, for a lot less than that, I could start my own practice.


So basically, I basically told them no. And so rather than take my money and I was gonna give them a lot of money, each they folded up shop, got not one dime and left, and that was it. And so now I'd already given my 90 days notice. So I had 60 days to start a practice. While still working at my busy job, I was curricular Dean and seeing patients and, it was really hard.


It was very, So I actually, the, the, what was great about that and what I can share with, students is that, the residents that wanna do this is that it forced me to come, It's forced me to get started without really thinking about it. And that was sort of this blessing. I had 60 days to start a practice.


I, I, you know, I'm the only salary, my wife's a teacher. I love her, but she doesn't make a lot of money to support our family. I can't afford to like not be at a job. I need to be up and running quickly. So it didn't give me a lot of time to think, how should I design this?


How should I do that? I just, like, I had to go. And that was a blessing because I didn't, I didn't have time to worry. I just had to go, go, go. And what I learned from that, you can just, you, this is not that hard to do. It really isn't. It really isn't that hard to do. Anyone can do it now. It's scary because they don't, we don't teach you this in medical school.


I actually, you know, eventually added some business of medicine in the curriculum. They actually still have me come back, which I'm happy to do as long as they'll have me to do the one session that the students get in business and medicine cuz we didn't have any of this stuff. So it's super scary, especially someone who's, out of residency, they don't tell you how to do this, but it can be done.


And one of the things I. Younger doctors. And again, this is no disrespect to to hairdressers or plumbers, but most hairdressers or plumbers have their own business without even a college education, and they do very, very well. You don't, you know it what? Passing step one. That's hard. Taking your residency boards, that's hard.


Starting a business, it's not that hard. It can be done. And then the other great thing about it is that you don't have to do it all. Your on your own. There's lots of people that can help you do this, some of which you'll pay and it'll be worth it. And some of 'em, you don't pay a dime. Like, where should I open my practice?


Well, there are people there. There are real estate agents commercial real estate agents that can find you the perfect, perfect location and give you all the pros and cons. And guess what? You don't pay them a dime because they make their money on the back end once they rent you that space. So, there's lots of things.


And so that's what I discovered, that that based out of necessity, I found people who could help. So that I do have to do everything, you know? and so, and it really, it can be done, It can be, It's, again, it's an, it's not that it's easy, you know it's gonna take work, but it's not like this impossible thing that you can't do right out of residency.


You absolutely can do it. You can do it at any time, any time in your career, it can be done. I did, it's toward the end of my career and I'm doing okay. So I love it and super encouraging. And I am very glad that you mentioned how, as the , curricular dean, that you had the, the viewpoint to say this type of.


Pointing out to people who are smart enough to get into medical school that they can also start a business just like anybody else who chooses to start a business. So I absolutely love that. And, going there, I, I, I wanna get into your practice in terms of your details, but I wanna, I wanna segue into the fact that you still have, involvement in teaching as part of your daily practice as a physician.


And so when you are working with medical students who are coming in and seeing the, your model and how your patients are, interacting with you and how they love your value proposition what are some of the conversations that you have with medical students in terms of are they seeing that entrepreneurship is a, a, a thing that, that they can achieve or they, are they learning that early on if they, have not yet taken your, your business seminar and.


What challenges are they throwing at you in terms of like, Oh, I couldn't do that because X, Y, z. So, that's a great question. So I, I'm very passionate about having medical students in the clinic, especially. I, I think all DPC docs should do this for a number of reasons. , the issue is, is that if, if everyone starts doing dpc, you know, there's not gonna be enough docs to see all the patients.


And that's true because we have a lack of primary care physicians. But why do students wanna go into emergency medicine? Why to go in medicine subspecialty. Why to go, why don't they wanna do primary care? It's because it's not fun. It's because it's a burden. And you don't make a whole lot of money.


It's not, Again, I don't think the students have changed. People go into primary care, don't necessarily wanna make a lot of money. They want to take care of patients and do a good job and have a life, you know, and be able to feed their family and maybe take a vacation once in a while. Nothing's really changed and.


Now you can do that. And so to me, it's every time I have a student, I wanna let them know. And again, I, we don't, not everyone can be primary care. We need good emergency room docs, we need good surgeons. So I don't try to talk them out of that. But I think, as someone who was on the faculty for 20 years, I was on the admissions committee for maybe 15 years.


So I spent a lot of time looking at medical student applications. And I can't tell you how many of them said, Oh, I wanna do primary care and serve the needy and all that stuff. And I don't think that they were lying. I mean, maybe a little bit to get into medical school, but I think they really meant it.


And what happens is, is medical school beats out the primary care and altruistic nature of most students cuz they see what a burden caring for patients are. In that setting in our healthcare system. So I think when you get students to say, Oh wait a second, this is primary care, you're gonna have a lot more students choosing.


To do primary care cuz I get these longitudinal relationships with patients. I have a good lifestyle, I'm making a decent living. Maybe not as much as an orthopedic surgeon, but I'm doing okay and I can have fun and I can have a life. And I get these great, and I spend a lot of time with them and that's why we went into medicine.


So I want the students to see that this is possible. And, one by one, try to convert at least some of them into primary care. At least have them realize that this is a possible career path. And not all primary care physicians see 25 patients a day, and, and, and, and are stressed out and have to go do charting at home instead of eating dinner with their family.


Cuz that's what they see. Because most of the students, when they do these, you know, whether a preclinical or clinical, they're usually doing it in the academic medical setting. And, and their preceptors are miserable. they're, they're not happy in the clinics.


And so that's what they see. So I want them to see that and want them to know that there's an alternative to do that. So that's, that's one thing. Awesome. And when you have conversations with your peers who are potentially in positions like you were when you chose to practice on your own or people who are, in those first few years out of residency reaching out.


For example, like Dr. Lon Burton, she had looked to transition her own life to a direct primary care model in pediatrics in the DMV area, and she had reached out to you. So when you're talking to peers what types of conversations do you have there most commonly? That's a good question.


There's a lot of things. So, what I wanna do is be a resource for them and help them. One of the things. And again, for me, I didn't really have, I had to get up and running really quickly, So for, one of the things I asked them is sort of, what is their vision? What do they wanna do?


Cause I sort of didn't exactly set it up that way. I just, I tried to create a business model so that I could be up and running very quickly. And I think if I, had the luxury to do it over again, I might have done it differently. So what is their vision? What happens is, is that, when you're starting outta practice on your own, and especially if you have the luxury of time, like people will say, I'm gonna quit my job and I'm gonna have three months or six months to set up.


A practice, they get very bogged down into the granulars of how am I gonna make it work? Without focusing on what's the big picture To me, the one thing I tell, younger doctors is figure out what your vision is. Recognizing that that might change over time, and figuring out how you might build, starting to practice to build toward that vision as opposed to figuring out how you're gonna generate income from day one.


Because to me, that's the most successful way to sort of build and grow a practice is start with a vision and work that way as opposed to, All right, well I'm gonna just, I have to make some money, so, and I don't wanna take in any loans, so I'm gonna do urgent care five days a week while I slowly build my, DPC practice.


I don't think that's the right way to go. Awesome. So. Again, I love those words of just taking a step back and, thinking about one's vision, because that could pertain to so many aspects in our life, whether it be our business, whether it be how we want to, manage schedules, whatever it is with our families.


For you, when we talk about you taking your vision for your practice, and yes, you had to transition quickly, I wanna say that , your last day of, full-time faculty was like June 30th, and then the same year on July 5th, you saw your first DPC patient, and so That's correct. So as you're, falling while building the plane, so to speak, how did you then create your vision as you went into your second, your third, your fourth, your fifth year?


Did you, did you stop and, as a, as a solo doctor, did you stop and say periodically, this is how I'm going to, Like mentor myself and take, time to figure out my vision. So it's interesting cuz the two are related cuz I would say that because I wasn't focused on vision, I made mistakes and that mistake actually led me to sort of the vision that I'm still working on.


And that's the other thing. Is that it's not, Well, I, on the one hand I'm saying, you know, figure out what your vision is and build toward that, it's okay that the vision changes. So what happened with me is, again, I had a concierge practice already, but because of the distance from my clinic, I only had a handful of patients, come and follow me and so I started out very slow and I started to get very nervous, cuz I was just going to get it up and running.


I wasn't really thinking about, was this gonna work or not. And So I was looking, Well, how else can I generate revenue while I build and grow this practice? And so, One of the things that I did early on, which ended up working out very poorly, was I started to dip my toe into aesthetics.


Which, and again, there are a lot of DPC doctors that do aesthetics, and I'm not criticizing that cuz that could be a very good thing. But that wasn't my vision. It was more of you know, I was thinking, there are other things that I can do. I can do legal consulting, I can do, other things.


And to me, I wanted to, I thought, I, I, I had been doing some medical weight loss in my previous academic practice. That was something that I was interested in, so I thought that might be a possibility. And that sort of paired with the aesthetics. And so part of it was, is that, I was at sort of the wrong place at the wrong time.


These companies that sell these machines are very, very aggressive. And so they, they caught me at a very , vulnerable moment and sold me on a machine that would help me, build and grow my practice. And it ended up not working out very well. But I learned a lot. And so that was good.


And so I, I definitely took a financial hit over time, but you know, it, there was some value in it as well. But the other thing that did happen that was good is that, or worked out well because I was open to new ideas. The aesthetic thing didn't work out. But the other thing that happened was a medical cannabis dispensary moved into my building several months after I had opened.


And again, I, medical cannabis was not in my vision, but I needed a way to generate some revenue. And and I'm like, Okay, if they wanna send me up, a couple patients to certify, what's the harm in that? But I found that I really liked it. I was really worried that I, you know, I was gonna basically giving people a legal excuse to, to use cannabis.


So I was skeptical, but what I found out was, I'm in Maryland, but I'm near dc recreational cannabis is legal in DC so if you just wanna get pot, it's very easy to go to dc. So the people that were wanting medical cannabis were really sick, stage four cancer mets to the bones, horrible nausea from chemotherapy, chronic pain arm narcotics, desperate to get off.


And I started seeing these patients and started recommending medical cannabis. And I saw that it worked. And that's what we wanna do as primary care physicians, as physicians in general. We wanna get people well. And so I ended up really liking this, and I was like, Okay, well if I'm gonna do this, I'm gonna do this the right way.


And incorporated in part of my practice. And again, just like we don't learn about business and medicine in medical school, we didn't learn about medical cannabis other than cannabis is bad. It's drug and you shouldn't use it. So I had to, you know, learn all this stuff and do some research and, if I was gonna do this the right way, and I, again, similarly, I figured if I'm gonna, if I put all this time, effort, and energy to learning all this stuff, I might as well publish it.


So I actually wrote a book medical marijuana and cbd, a physician guide for patients available on Amazon now. And and actually cuz I, it wasn't out there, there weren't books for docs. So, so I ended incorporating that into my practice and really liking it. And then going back to vision, and again, I'm still working on this, One of my biggest fears of leaving academia besides like not being able to support myself and my family, one because actually that's not true.


When I had investigated this 10 years back and met with people like Dr. Din and other people who were successful, I knew that I would be successful. I was worried, but I knew it would work out for me. The actual issue when I started out the second time, was a time factor because now my kids were older.


My kids about to go to college in a couple years. Like I don't have 2, 3, 4 years to be financially successful. I have to get financially successful now. Cause I have college tuition payments coming in a few years. So that's probably what made me do things that I probably shouldn't have done, like. You know, Aesthetics.


But one of my biggest fears actually was that I would be bored because one of the great things about academic medicine is you get to do a lot of things. I was doing research, I was doing education, I was doing curriculum. There were all these fun and cool things that I was doing. How am I gonna just see patients every day?


That's gonna be so boring. Like, I, I love primary care, but I've never, except for maybe my first year as faculty 20 years ago, I met, I've always done other things and was I gonna get bored? And one of the things that I found out was I really, not only did I like the medical cannabis piece, but I like the variety.


I like sort of, doing other things just besides primary care. The other thing about medical cannabis is I found I'm now a specialist. I'm getting referrals from my colleagues, so I can wear my primary care hat on and my generalist hat, but I can also wear my specialist hat. And so one of the things, as I evolve and change my vision for the practice, I like the idea of doing these non DPC services.


So for example besides the cannabis uh, I do treatments for depression. I, I mentioned that I had done some medical weight loss. I didn't really focus on that early on, but now I've reintroduced that. So I'm doing medical weight loss. Again, I do all this stuff for my regular DPC patients at no charge, but for my non DPC patients, it's something that I can do and not take insurance and do it as almost a specialty.


And the latest thing, and this is literally as of the last, week or so, is I've actually, started to offer um, treatments for long covid. That's, to my knowledge, the only people that are doing this are the academic medical centers. There's a lot of people out there. And so I'm, and and it just, it's, to me, it's interesting.


So my sort of vision now is, is changed over time, but it's really to have my primary care practice but some other things that I happen to be interested cuz I like to learn and, and do things. And my guess is it will change over time. Awesome. Also, I love that you share that because that's encouragement to be okay with that too, right?


Because I, I totally feel that to my bones in terms of the, the feeling of I have a patient in five days cuz I'm opening a practice. I'm sure a lot of people can relate to that. Given all of the stories we've heard, especially during the pandemic where people have lost their jobs for whatever reason, at a very, very quick turnaround, they have chosen to do direct primary care.


So, I, I appreciate you sharing those words , now in terms of when you mention how you have your direct primary care practice patients and then the services that are included for them, but then you also have your non-direct primary care patients.


How do you operate an onboarding when it comes to a non DPC patient versus a DP patient? Good. That's a good question. So, I mean, I think, DPC is part of this whole direct care movement. Again, the problems with most of our healthcare system. There are many, but health insurance is one of them.


And so we have this direct specialty care movement, Direct primary care movement. It's about direct care cuz it's, it's a much taking that insurance middleman out of the picture. Now, dpc, when we think about dpc, we're generally talking about. Sort of DPC is the business model, sort of a monthly membership, no insurance, But there, and there are many ways to do that.


Again, the, the doctors that I was gonna buy the practice from, they were doing direct care and they were doing primary care. They weren't using the DPC model, but one could argue they were doing direct primary care. They were just doing it a different way, a cash fee for service way of doing that.


So when it comes to my non DPC patients, my non-membership patients, it's the same way. It's a cash fee for service, just like our direct specialty care colleagues would do very upfront with pricing. I create memberships for that. So, for example, the medical cannabis, when, you know, I use Elation as my emr, we onboard them the same way and we just create a membership called medical cannabis.


We, and we don't bill them monthly, they just pay me the fee. And, you know, I invoice them. That's a whole other conversation. So I give them an invoice. Because I know, I know that's a very touchy subject to DPC world, but I'll give them an invoice , to submit to their insurance company so that they can get reimbursed, which I think some of the d direct specialty care doctors will do.


But I don't deal with the insurance at all, so it's a straight cash fee for service. Give them an invoice, but it's the same emr. It's pretty much the same thing. It's just a different membership. And when you look at like your PN L for example, do you have a certain number of patients that you put into your p and l or do you only put into your pn l your direct primary care patients and then that's just diversifying on top of your pn L for the practice


It's very interesting. I think about it in a different way. I think of it as time and , essentially what I'm charging for is my time and I only have so many hours of the day. So, there's a reason why. Most concierge doctors and DPC doctors have about 500 patients.


So in concierge it's about 500 dpc because we DPC doctors, don't promise the the concierge level of services so they can have a few more 600, 700 patients. But there's a reason why there's that subset. And so basically when it comes from a business standpoint or from a PNL standpoint, you basically figure out, alright, what are my overhead costs?


How much am I gonna charge for these 500 patients? And that's what it is and how much salary am I gonna make? And so, most DPC practices can operate at, you know, like a 30% overhead, some even less. So you can, the numbers are not that hard.


This is why this is not a very hard thing. It, it's really not. I mean, I don't even use the term, I mean, my accountant will tell me what my p and l numbers are, but I don't even look at those. I just know that, what is my panel size gonna be? So I think of it in a different term. So rather than have 500 member patients, I've decided I'm gonna have 400 patients.


Okay. and I can see, x number of, of medical cannabis patients a day. And as I start to expand my services so I inherited a lot of, a lot of my DPC patients have come from concierge doctors who have. And so those patients are a lot older.


So my attrition rate by natural causes is actually higher than I think your typical dpc. My, my oldest patient who was 103 and changed, just died the other day, so, when he signed up he was 101. So I had a feeling that he wasn't gonna be a long per patient. And so I have a lot of patients in their nineties and, a lot in their eighties, but a bunch in their nineties and a few, closing in on a hundred and stuff like that.


So my new sort of model is, is I will actually let my practice attrition to maybe even a smaller number as I start to add the services. I haven't quite figured out the exact balance. Oh, that, But it's really more of a time issue than a p and l issue, if that makes sense. Love it. And I love that explanation.


I think that especially for those people who might have started without a p and l it gives them a different way to think about things. Well, here's a, here's a, here's a free, a free sort of rule of thumb that I came up with for your podcast listeners that I think is very interesting.


So, if you do the math, if you, if you go with 500 and you assume a week, year, you need two weeks to make the math easy. Hopefully it's less than 50 weeks. But to make the math easy, it's 50 weeks, 40 hour work week, that's 2000 hours.


Okay? So divided by 500 patients, that's four hours per patient. And that math seems to work out. So the way that I think about it is that my average patient, okay, is gonna, it's gonna be an hour for a physical, an hour for two follow up visits, and then two hours of administrative time. And that's the average Some patients, Maybe I just see them for a physical once a year and maybe they have no admin time and some patients are high utilizers and I'll see them several times and I'll be on the phone prior authoring meds and, but, but that average seems about right.


So if you are trying to figure out panel size or how much you should charge, what you do is you take your membership, your annual membership, divide that by four, and that's your hourly rate. And that's basically what I do. So when I see a cannabis patient that's, a half an hour. Okay? And so I'll take my hourly rate and divide that by half, and that's how much I charge them.


And that's, that's the conversion of money versus. Is that, how many hours am I gonna spend? And the one advantage of doing the non DPC services , That's the way that you could convert money versus time.


And one of the advantages is, , the non DPC don't require those two hours of admin. They're just straight time. And so that's another advantage of doing non DPC services, is that you can free up some of that time. Super helpful takeaways, so thank you for sharing that. And when we talk about your practice, you've stopped accepting.


I, I know you mentioned how you let your attrition rate go down a little bit. And then so you can have the time to do non DPC member care. But in terms of when you decided to lower that number to 400 and you closed your, practice to, to new patients in your fifth year tying back into vision as well. How did you come to deciding that 400 was the good number for you versus like three 50? And then in terms of vision for the future how do you reevaluate, is it Q3, months or whatever to say this is a good number as I've , let my attrition go down and I've increased my cannabis patients or whatever other services to non DPC members that you can find that happy place going into the future.


Given that you said vision can change all the time, Right. So I, I don't have a , a plan in which I say quarterly or annually or yearly. I sit down and go everything and review that. I think that's a good idea. But that's not the way I, that's not my dna.


I don't do that. I'm constantly thinking about my practice, what I like, what I don't like, what could I improve, How could I do differently, what I might wanna do. Some of that is influenced by my DPC colleagues. One of the reasons why I like this social media is because I see what other people are doing and I'm like, Wow, that's really cool.


That's really unique and interesting. So, as an example, I mentioned briefly, you know, that I'm starting to do some treatments for long covid. Where that came from is I saw that some DPC doctors. We're doing some functional medicine and some alternative medicine, and again, I'm a traditional internal medicine, academic, full way.


And what's interesting is the cannabis thing, sort of opened my mind to maybe some alternative things. And I saw some DPC doctors doing these kind of things and I'm like, Well, what's all this about? And ask some people and talk to them and started doing some research and I'm like, Hmm, this might be something that I want to do.


And so, my way of sort of dipping my toe into functional medicine is by doing long covid, cuz I think there's a, a huge need and it fits that paradigm and so we'll see. So, My vision is constantly evolving. Might I do more functional medicine stuff? I might, I don't know. But I'm thinking that sort of as I go through these things.


So taking a step back, when I started this and had no vision, it was just sort of panic mode. How do I generate revenue? Oh, let's buy this machine and, and do some, fat reduction. And hopefully that works to sort of, happily landing on medical cannabis and deciding, you know, this is something that I wanna incorporate.


I really like helping people this way and doing something different than primary care, sort of finding this specialty. So that was sort of evolving and I, as I was thinking about how am I gonna incorporate these two things, I thought about this sort of , time, revenue, standpoint.


And how did that work? And sort of came up with this sort of four hour average number and, what was that balance gonna be and how many patients were I seeing per week? And if I was seeing two cannabis patients a day with that would be the right balance. And doing some of that mathematics, That's where I, I came up with that, that and in fact, You have to be very careful.


So I actually purposely priced my fees for cannabis much higher than my competition. Because I only wanted to, number one, I only wanted to see the real sick people and the people who really wanted a doctor. I didn't wanna see the people who just wanted a certificate. I wanted someone who wanted clinical advice, so I priced myself.


But I also, like, I couldn't see 10 patients a day because that would take away from the time that I've promised my dpc. So to me, sort of, it was almost like an 80 20 rule and it seemed to work out really well. So I did a lot of these sort of napkin based calculations and sort of 400 was, seemed to be, sort of the right number, but I also wanted to guarantee that 400.


So I decided, I built in a little buffer and originally I was gonna be four 10, but I bumped it to four 20 cuz I thought it would be funny cuz of the cannabis. And so I, I came up with my four 20 buffer and I did that for a while. And as I'm adding these new services, I sort of let that come down back to the 400.


And that's sort of where I am now and we'll see. And my guess is in a year from now I'll pro hopefully be in a very different place. Now I, I'm gonna laugh every time I see someone reference the four 20 method of Dr. Mince on one of the, the DPC Facebook groups. I love that. And in terms of practicing in your geographic location, because you grew up around the area where you're practicing now, you practiced for, so many years doing the one hour commute.


If people are looking to open in the DMV area, what things would you challenge them to think about in terms of choosing a location? In terms of the cost of living, in terms of any legislative differences because there's so many, you know, different states and the, District of Columbia all within that, region of where you're practicing.


So I'm gonna answer your question, but I'm gonna general. And what I mean by that is, this is a good question for sort of everyone, and the point being is that the answer depends on your location. Now, if you are not weed to a particular location, then you have a lot of flexibility. In other words, if you wanna serve the underserved and not charge a lot of money, and live in a rural area and that's what you wanna do, that's fine.


But if you live in the Virginia or Maryland suburbs of dc, that's gonna be hard to do. , So a lot of questions you, people ask you, How much should I charge? Should I get a loan? Should I do this? Should I do that? A lot of the answer is, it depends on what your, what your practice vision is and where you live.


Cuz your biggest expense, your biggest cost is gonna be your staff and your rent. And that's gonna be heavily influenced about where you are. so the, so is $70 a month the right membership fee? The answer is, it depends what services you offering, Where is your practice located, you know, et cetera.


And so, one of the challenges for DPC is sort of the value proposition because the access proposition is super easy. The, the value proposition is a little bit more challenging, but it depends on where you are. So, getting back to your question, in my area, the, the Fairfax County in Montgomery County surround the District of Columbia, they're the two wealthiest counties or two of the wealthiest counties in the country.


The biggest employer for the region is the federal government, which has amazing insurance benefits. So I live and work in an area. That, the penetrance of concierge medicine is much higher than the rest of the country.


So I don't know what the national average is. Let's say it's 3% or 2%. And in our area when I started it's 5%. Now it's probably six or 7%. So to me to try to open a a a DPC at $70 a month is not gonna work. One cuz I can't afford it cuz the rent's really high and my staff is really high. So that's out of the window, out of that's not gonna work.


But also, people have insurance and it's good and it doesn't, and a lot of them, it doesn't cost a lot of money. And so like to try to sell them on not using their insurance is really hard and they know what concierge is. The problem, the pain point, they can't find a doctor. No doctors in our area are taking new patients.


There's no primary care physicians coming in. All the older doctors are leaving or retiring or going concierge. You cannot find a primary care physician in our area, and if you have one, forget about getting an appointment or a physical or anything like that. So what I did is I wanted to start a dpc, but I basically just called myself a concierge doctor.


I was already a true concierge doctor in my previous job. I'll just use that and market it. And when people ask me how am I different from N D V I P, I can sort of explain, what DPC is. But I don't even have DPC on my website. And again, part of that was because my kid was about to go to college in a couple years and I had given notice and it didn't work out.


So I had to be up and running pretty quickly. If I left 10 years ago, I might have done things a little bit differently, , so that one of my, you know, essentially is to think about those factors if you're starting in my area. And, if you don't wanna call yourself concierge, and I totally, you know, as a current concierge, former concierge doctor, I understand that.


Cause like I said up front, I didn't wanna be a concierge either. I want, this is for everyone. I wanna treat everyone. If you don't wanna do that, one of the ways that I've is. Market yourself is concierge without the concierge price tag, and instead of trying to sell people on dpc, I do everything that a concierge doctor does, I'm just not gonna charge you as much.


And, and that would be sort of one piece of advice that I think will work very well in this area. But other areas as well. You know, Anywhere, anywhere that's a suburb or even in a major city, but that's probably not gonna fly Middle America. where insurance is a problem and people are not well insured, they're underinsured, and cost is a big issue and they want you to, buy the generics at cost and, save a few dollars.


That's not gonna work in my area, , so you really have to look at who are your patients, where are you working, where do you wanna look? Build your vision. And then those things dictate those decisions that people fret about. Awesome. And in terms of just putting some more details about your practice, the people who have found your value proposition insanely in alignment with what they wish to have as a, as a healthcare access point, quality point, whatever you wanna call it.


You said that you have a higher number of people who are older in your practice, but in terms of the, the patients, given that you are in the DMV area, I wanna ask how many of your patients have that amazing federal insurance and still see you as their physician? A bunch of them do.


, I would say I have a lot of Medicare patients most of my patients are well insured now, a lot of Medicare patients, either Medicare Advantage plans or straight Medicare, bunch of federal employees, or local government employees.


Like, so for example, the school system has amazing insurance. So a lot of very well insured people and, and you and they're happy. And the reason why they're happy to do that is because their insurance doesn't help them when it comes to primary care, because there's just not enough of us around and they can't get the appointment.


You know, They don't wanna go to urgent care, They don't wanna have to run to the emergency room. They don't wanna have to wait three months for a physical. And it's a high pain point. It's a really high pain point. There are really no doctors. There are very few doctors to begin with in our area, and no one's taken new patients.


It's a real big problem. It's a huge problem. , I had to point out to one of my new patients the other day that if they looked in the back of their insurance card, it said that this insurance does not guarantee healthcare.


So it, it's so interesting that so many people believe in our culture that I have the magic card. I can swipe it like Dr. Jeff Gold says, Just look that credit card now. . So when you talk about access in your practice, one of the things that is featured on your website is that there's 24 7 access to telemedicine. And so in your years of practice, can you speak to the fear that some people might have? Like, I can't be on call as a solo doctor because I wanna go on vacation, or I wanna do, the things that I I love, like sleep.


So how do you address the 24 7 access to telemedicine in your practice and how has it affected your life outside of your clinic? That's, that's a great question. so again, going back 10 years ago, or 15 years ago, when I decided to do the concierge practice as part of the academic practice , that was the first thing that my colleagues, questioned me.


Are you crazy? You're gonna be on call all the time. And it was coming from the way we did. We didn't do any inpatient coverage. We were all, we were about 20, 25 FTEs that covered the primary care patients for the faculty practice. So the fact the GW faculty practice is the largest multi-specialty group in the District of Columbia, at the time there was 20 to 25 FTEs for primary care.


The, the, the practice itself probably served about 30,000 patients, maybe more. So when you were on call, you were only on call twice a month. But when you were on call, you were on call for the entire. Practice the entire 30,000 patients. And you, it was typically like a weekday and a weekend day.


And so, when you were on call, at five o'clock when the phones rolled over, the first 10 calls were, I called in this morning and my Lipitor wasn't called in. You need to call in my Lipitor now. So you were basically, you know, you had those string of phone calls and sometimes it was a busy middle of the night, but you were, you were stuck at your house or if you, it was your turn to do Saturday morning call, you couldn't really leave because there's all these calls.


So even though you did call twice a month, it was hell for those two half days, twice a month. And what I found out was when I switched the concierge, the opposite occurred, which is when patients have access to to you during business hours, they don't bother you. And so I found that I almost never got called and I was like, I am never going back.


I could never do that again. It was, it was wonderful. And so, Part of this is setting up the expectations and that's the key. And I do this at the meet and greet. So I do a meet and greet for every patient and I set up these expectations at the meet and greet, cuz that's the question, people ask, how can I reach you?


Or on call or whatever. And so here's the spiel that I say, I say, if you are sick on Sunday and you wanna come in on Monday, you don't have to call me on Sunday. My assistant gets in the morning, you call her in the morning and we'll tell you when to come in. And if you have chest pain and can't breathe, you call 9 1 1.


But if it's three o'clock in the morning and you are not sure whether this can wait till tomorrow or you have to go to the emergency room or don't know what to do, that's the kind of call that I want to take. And so when you say that to patients, they really get okay if it's. Really only if it's a tru.


If I really don't know what to do, that's when I call Dr. Mince and I almost never get calls. Almost never. The other half of that, and this is important, is I make sure that the business of today is done today. So if you call me or email me this morning, I don't leave the office until I've returned your call or returned your.


And does that mean sometimes I stay a tiny bit later than I would love to? Not usually, but it, it can. But I've sort of set that up as my mantra and what that does, it affords me when I go home, I'm home. Like I don't even, put my cell phone, I leave my cell phone upstairs. I can hear it ring, but I don't like carrying my cell phone around, stuff like that.


And so I almost never get calls after hours on the weekends. And again, I've been doing this, this same thing for, I, five years of my DPC and 10 years before that in concierge. And it's great, It's fantastic. So I've done 24 7, 365 for 15 years. The exception was I had, I had a surgery and so a couple, of my colleagues had to cover for me for, a couple days.


But other than that, I've been doing it forever and it's been great. It's been wonderful. Awesome. And when it comes to testimonials on your website, you have a whole section about testimonials. So especially for people who, they might not be a direct primary care patient or looking to be a direct primary care patient, but even just a testament to you as a physician you have many examples.


How do you approach testimonials when you're reaching out to DPC patients versus your non DPC patients? So I think this goes back to something that we talked about earlier, is that you don't need to know everything. You just need to know , what you do know, and what you can do and you don't need help, and what you don't know and where you should get help, and whether it's worth paying that for a lot.


So here's, like, like, again, I'll get your question, I'll answer that question in a second, but I think this is a really important point based on comments that I see, you know, on, on some of the social media. Fortunately for DPC doctors, young DP doctors, there's ton of resources. There's, kudos to Josh Umber and, and And Atlas and, , they have a lot of resources and there's primers and there's people that have written books about it.


There's some really good books out there. Doug Brag has done that. There's a bunch of books out there that you can do. There's all these like dpc, masterminds and conferences, and you can go to that and everyone should do all those things if they're interested. But for some people even that much, it's still overwhelming and that's okay.


Not everyone is a DIY kind of person, not everyone's like that. And it's okay if you want someone to hold your hand, and it's okay to pay for that Now, make sure that if you're gonna pay for it, that , you pay for someone who is a DPC doctor themselves, when has done this, not some sort of medical consultant that knows the insurance world because the rules don't apply.


It's okay to ask for help. It's okay to pay for help. I bring that up because, I don't know anything about reputation management. I don't know anything about testimonials. The reason why that is so good is because, and this is interesting, this goes back to one of the perks of the big aesthetics machine was they gave me a website for free.


There was a lot of perks that came with it. And that was one of 'em. And, and I'll just say the, the, the website is patient pop, that's the, the website I used. And they did such a good job with seo. And again, if you don't know what SEO is, that's okay. You need to have good seo. And if you don't know what that is, you could hire people to help you with that.


And you go with a website like, like patient pop that does your reputation management, stuff like that. I didn't know anything about that. But patient pop is really good with SEO and really good with reputation management. And when patients book online, they get an email to say, Did you like Dr. Min? And if you do, then you rate them.


And so I've got this amazing, you know, testimonials. The only testimonials that I ever sought is I thought it'd be a good idea to put like on my website, two video testimonials. So I have that from when I first started. But everything else is all organic though I don't lift a finger, it's just done behind the scenes.


cuz I have a website that knows how to do that. And it's interesting, most of my patients. Even regardless of the service, whether it's for DPC or for medical weight loss, it's, I was Googling X, you came up, you looked very professional and you had amazing testimonials. And all of that's because I I bought an expensive box that didn't work out, but got a free website and they did such a good job.


I decided I would pay for that and I pay for that now. And it's a good ROI because of exactly what you're saying. Awesome. And we'll make sure that the links to your book, the links to articles you've written, the links to the, the patient pop website is on your blog. So thank you so much Dr. Mintz for joining us today and sharing your story.


Thank you. It was great talking to you.


 Next week look forward to hearing from Dr. Brian Oik of Health and Healing DPC in Woodland Hills, California. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about dpc. Leave a five star review on Apple Podcast and on Spotify now as well.


Others to find all these DPC stories. Lastly, be sure to follow us on social media. 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.

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