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Episode 113: Dr. Amber Beckenhauer & Dr. Maryal Concepcion

Updated: Mar 14, 2023

Direct Primary Care Doctors


They are Calibraska sisters!
Dr. Amber Beckenhauer & Dr. Maryal Concepcion

Dr. Beckenhauer (she/her) is known by almost all of her patients as "Dr. B." She grew up in the small Nebraska town of Ashland where she now has a second location. She completed her medical degree at KCUMB in Kansas City, MO from 2004-2008, and finished Family Practice residency in Lincoln, NE in 2011. In July of 2011, she moved to Blair with her family to begin employment at MCH & Health System. From 2011-2017, she not only practiced Primary Care at the clinic for all ages, but also delivered infants by vaginal or cesarean delivery, staffed the Emergency Room, served as Medical Director of the ER & Blair Clinic, and lastly served as Medical Staff President before her departure. From 2018 on, she continues to help the local hospital by working in the ER and delivering babies vaginall and by C-section. Dr. Beckenhauer enjoys teaching Family Practice Residents in her spare time, and started at Nebraska Medicine/Clarkson Family Residency Program in the Fall of 2018 to help promote the education of Rural Family Practice.

With her Osteopathic Medicine background, whole person healthcare resonates with her. It also drives her passion for Integrative Wellness and Hormonal Balance. To further her studies, she has completed courses for the American Academy of Anti-Aging Medicine. Dr. Beckenhauer believes that Passions Starts With People, and we can all make a difference...ONE Patient/Person at a TIME.


A Sacramento native, Dr. Maryal Concepcion (she/her) is a Filipinx creator and connector. She attended the University of California at Davis where she graduated in 2005 with a double major in Anthropology (BS) and Evolution & Ecology (BA). She had an unforgettable time as a California transplant when she got her MD at Creighton University in Omaha, NE. It was there she discovered hayrack rides, found her husband, Dr. Jeremiah Fillo, and discovered her love of rural family medicine.


Her residency training was in the unopposed family medicine program at Doctors Medical Center, Modesto, a training extension through the UC Davis Medical School. During her time in training, she returned to Brodstone Memorial Hospital in rural Superior Nebraska to complete proficiency training in performing colonoscopies as part of her rural family medicine concentration.


After residency, she moved to Arnold, CA (home of Calaveras Big Trees State Park) where she worked under the fee for service model with her Husband doing full-scope care for over five years. Though grateful for her experience in this role, she was driven to seek a better way of life and a desire to practice insurance-free medicine and that was when she discovered DPC.


She is the founder and host of the podcast My DPC Story, the award-winning weekly podcast that educates and inspires by featuring DPC and direct care physicians.


Most recently, she became the CEO and wearer-of-all-the-other-hats at Big Trees MD, the first Direct Primary Care in Arnold, a rural town of about 4,000 in the Stanislaus National Forest located in Northern California. Her clinic was created as a telemedicine and home visit model without a brick and mortar space and Dr. Concepcion transitioned into incorporating a physical location in October of 2022.


Still, the title she is most proud of is being a Mama to Asher & Nolan, her two ridiculously awesome and cuddly boys!


 

Big Trees MD Clinic Pictures!


 

AAFP Family Doc Focus Article

Featuring Dr. Concepcion:




 

PODCASTS:

My DPC Story Episode 14: Dr. Amber Beckenhauer

My DPC Story Episode 70: Dr. Amber Beckenhauer & Dr. Maryal Concepcion - Year 1 @ Big Trees MD


RESOURCES RECOMMENDED:

- DSC Alliance (Direct Specialty Care)

- Nuts & Bolts Conference by Docs 4 Patient Care

- DPC Frontier - the go to resource for legal articles, the DPC Mapper and more by Dr. Phil Eskew


CONTACT:

Contact Dr. Beckenhauer HERE

Contact Dr. Concepcion HERE

See Dr. Concepcion's practice, Big Trees MD, HERE and you can call/text her at 209.653.2135.


 

Watch the video HERE:


Listen to the episode HERE:


 

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Transcript*

 Hello. Hello, Amber Becker. It's so nice to see you again. Live time. Yes,


absolutely. I feel like I'm in California right now with this great on background.


Had to, had to bring the C Nebraska part today. So super excited and, you know, we'll, we'll get into it in a little bit later, but it has been such a wonderful year being back in person for certain events and especially you and I, you know, sisters from different mister got to spend time physically in the same space for multiple days.


And it was just, it was just such a treat just to see you live time is always a treat. So I was super excited to talk with you.


this little gal right here got stuck with me in a car for about three hours coming back from Kansas City. We spent DPC Summit together, right.


And we got a talk on stage and enjoy each other and all of our other colleagues. And then Marielle came back with me to Nebraska to check out our brick and mortar locations in Ashland and Blair. She did some patient appointments while she was here, learned from our nurses and from myself and gotta meet our pa.


So it was a really good time. And Over this year. You've been a lot of places, right? You went from doing only podcasts and being on the phone with your patients to now you have your new location open, right? Just in the last couple


weeks. Just in the last couple weeks.


, it's a perfect time to feel do this interview because having a space after not having a space for a little over a year. it really brings a different perspective and also seeing your clinics and, Dr. Becken Hower did say locations plural because she has three amazing locations and seeing those spaces and the number of DPCs that I've seen in person is very few.


Unfortunately, up to this point, I've seen Dr. Janine Rod's office, I've seen your offices. And it's just so. It's a different feel. , it's not a good or bad thing in any sense, but it, it is such a different feel. And for me it was very inspiring to have, you know, I still think of the day that I saw Dr.


Rodin's office by appointment only was office availability. And for your office, you know, it's offices, excuse me. It was so cool to see how you interacted with your patients, with your staff in a physical location. And so it is true. In October I opened up Big Trees md a physical space, and I've seen about four patients of my own practice in the location.


And then I actually ran a free flu clinic for the community. So I'm working with the local public health department to bring clinics like this to our community and to have a physical space where people can see, oh, there's actually a medical clinic here in Arnold. This is amazing. I didn't know this existed.


it definitely was. A way for me to share with the community that I existed but also just to hear the feedback of like, oh my goodness, I couldn't get down the hill 30 minutes to get my flu shot before they closed. And I don't get off of work until, you know, all those stories. And so just really being a community based physician now with a community based physical space, it definitely brings a different layer to Big Trees.


Md.


what would you say are the biggest. pros and cons. I mean, you interview all these people for, you know, at least over even the last year and every day you're just thinking about in your mind, what would my office look like? When is this gonna happen? When you put those things into perspective and drive around to Ikea and Target and everywhere else, all your decor.


I mean, , what do you think was your biggest perk or your favorite thing about opening that office or getting down to that?


That's, those are great questions. I, I would say that for me, one, I am blessed in that like I can drive to Ikea cuz some of my dear friends cannot easily drive to Ikea.


and target you know, for that matter. But for me, what I was able to do, just like I did when I even opened my dpc, was I was able to pull from the experiences of so many who have gone before, just like yourself in terms of, you know, things to look out for in leases ways to think about your space so that it's most efficient and keeping overhead as low as possible.


Ways to think about, okay, if I get a space, then what does that entail in terms of renter's insurance, et cetera. And so for me, , one of the biggest impacters I think on me in that space in getting a, an actual physical space was Dr. John Jacobson, who's, you know, your neighbor in Nebraska when he said, and people can go back and listen to his episode.


he had said the, quote of , why buy what you can rent? Why rent what you can steal? And I didn't get to the stealing part, but I do feel that in terms of the, the rental and the shortest term lease that I could negotiate.


I was very thankful to find a space that was in the heart of where my ideal practice would be. In terms of my town, it's not that big. You know, where we're along a highway one, one lane in each direction, but my location is across from the fire station. And I'm working with the fire department to do services for them over this next.


Including like just doing flu clinics. Like they, they can't easily get to do flu clinics or get to flu clinic locations. I'm across from the ACE hardware, so if I needed something that's there, I'm walking distance to the post office, to the library to the school, to giant Burger, which is a, the, the only burger joint in Arnold, California.


So, I feel that the location is great and I had thought. Location on top of terms of lease. And in terms of my term of lease I was very, very grateful to have the confidence to say, look, I am looking for a place, but I would like to try the place out first. And so what I did was I negotiated for a six month lease with a three year option after that.


So for me it was like, great, I, you know, I haven't installed anything in terms of doing a build out. I strategically said, okay, the way my office is set up, is that there are two floors two bathrooms that are upstairs, and then I have a space, a clinical space and like a waiting room area on the bottom.


And so my space is about 1300 square feet. And. My strategy, because we live at 4,000 feet, was to have the heat be really isolated to the exam room where I see patients. And so that would save me on electricity. I have a six month lease to find out what would buy my overhead cost be for my location.


My renter's insurance was like less than 500 for the entire year, which in, you know, a high fire area was, I was grateful for. And so I just feel that, getting back to your question, pulling from other people's experiences, Dr. John Jacobson, what other people had shared about their own leases and their own, experiences and having a space really helped me just quickly get into.


Once I found a space, , these are the, the furnishings that I do and do not need. And I will draw an amazing story here. I, I totally believe in, you know, the idea of good juju. And so for me, the story of my exam table is an amazing one. So I was, I had been on the, the lookout for a table for a very long time. Just, you know, I was ready to store something if the, if the price was right, if the timing worked out. But I, I couldn't find anything. And then literally, I think two weeks before my lease was to start I had found on Facebook marketplace a physician in Napa who was giving her table for free.


And I said, so, Like, is it really, truly for free? Cuz sometimes people put free on marketplace and then it's actually like 49 9 that they put free for, you know, to bait you. And so


moment you can, you can find about anybody anywhere and, and have a story from, right. This is true. This is


so, this is true.


This is so true. I mean, on, we're standing in Omaha,


you and this girl in that parking lot when I'm doing Botox injections for research. You, you're like, oh, I, I know you from Facebook. And I'm like, this is really happening. Oh, from California and you know this doctor standing in this parking lot, it was you and this is how this exam table went down,


right?


Yeah. This is, this is so true. And just some backstory there. Dr. Becken Hower had to go to a, a, I don't know what you'd call it. Like a, a side gig type of situation. Yeah.


Boom. Lighting. I, I helped do Botox injections for a research company. Yeah. For one of the research studies. And I had to train this doctor that day on injecting for this study.


And as we're walking out to meet Maryelle, and this is our typical life, Dr. Ion's life with Dr. Here we go. So she's waiting for me in the parking lot as she has shopped three bags full at world Mar, or no, sorry, it wasn't world, it wasn't World Market. Darn it. What's the name of it? The Whole Foods. Not World Market Whole Foods.


She's got fines for my kids, fines for her kids. Not really sure even how she's gonna fly back with everything she. She's waiting in my car for me, and I walk out with this doctor, I introduce them, and then pretty soon it's like, wait a second. Don't you have a podcast? And aren't you so and so? And I'm like, really?


Is this really happening right now? It


so random. This is


how the exam story goes down though with your table. So it totally does, it totally does all the different lives and all the, all the dots that connect. And it doesn't matter where you're at, Cal, Nebraska or where you are, but


yeah, it's so true.


And so for this amazing story, what had happened was. so I find this table offering on Facebook and it says free. And so I'm like, oh, this is great. It does not look like it's destroyed. I don't have to reupholster it, it, it looks perfect. So Napa is about three hours away. And so I contact the doctor and she's like, Hey, , just call me and we'll, we'll talk about it.


So we ended up talking for about an hour. It's Dr. Amy Burkhart who is in Napa, California. And she, everyone is a tremendous celiac expert. And so her, I'm just gonna drop her website. It is the celiac md.com. She is a, Wonderful human being. And she had ironically been practicing insurance free medicine for, I believe, 12 years is what she told me.


And so she had no idea about direct primary care. She had no idea that people were doing this under a membership model. And it was just, you know, you know how that happens when you tell someone about dpc, especially another physician, especially one who's not been taking insurance for her career. And then the conversation just continues.


And so it was such a cool thing to have that person be the person where this table came from. And so, there was a company, I, I, I will drop another company name I had no idea about, I don't know where it's located, but for me Lu, l u g g was an app that I used where it's like an Uber for moving. I just put.


This is the item that I need moved. This is where it's going to and from. And then magically it appeared in Arnold, California. It was supposed to arrive.


Just my favorite was like though, when you're, well, I didn't really know if it was gonna show up. Just this had the hope that it would, my table might be arriving today, it may not be.


I'm like, this girl, she will do


anything just absolutely. And, and was like, well technically it's free. But the move was like, you know, around $400. Mm-hmm. . And so that was pretty amazing for me to not have to drive, pick it up, drive back, unload it. And yes, that is very true. I had this like, does this actually work type of feeling that,


that you and I show up?


I may not.


Yep. This is true. And. Thankfully, I I have a table. It's been with four patients already, and it's, it's been great. But yeah, I, I think that for me my space allows me to have an exam room for, you know, whatever I need for regular family medicine stuff, but also to have that nontraditional office.


I will post pictures of my office in the blog pictures. Yeah, yeah, absolutely. Okay. But for my waiting room type area I have a measure mat that, you know, I can, I can measure kids and do exams, watch them move around. Do you know , the general doctor thing without having to be in a doctor's room, because I have this whole waiting area that really technically is an exam space because I don't have more than one patient or family in the practice of this.


. At one time for, you know, regular family practice hours. And so I think that that is also something that I, I haven't been able to do easily and ever in, in a clinic space. It's always been bringing your kid into the exam room, especially when I was in fee service. Let's have you wait, you know, 45 minutes, hour and a half, and your kids are jumping off the tables and all the crazy things.


And now it's like, there's a, I have a, a little tent that I popped up that has some fairy lights and kids, and I, I, for me, you know, listening to other people and hearing, the stories about how kids use spaces, for me it was even down to, I have textured pillows of all sorts of textures. So if a kid is, you know, sensitive to something that even the textures, they could potentially find something that soothes them or that if I feel comfortable with, and I have this IKEA kid's table with The place mat type thing. It's like an ocean scene where kids can scribble. And so it's been great too that like Asher will say, mom, can we go to your office after school? So pick him up. And he's, yeah. And he's drawing the crayons at the table and now he can read in the tent and his brother can later on.


And so I think that It's a very different layer of, of the practice again. And then upstairs I envision a lot of possibilities. I don't know what it's gonna look like, but I envision having a space also for things to happen that are community based. So, envisioning working with the public health department to do public education classes on, you know, dental, health and kids or whatever it is.


And then also I've reached out to our community college, I don't know what will come of it, this, over this next year, but they currently do not have anyone providing health services. So, you know, as a community based physician doing direct primary care I have the ability to say, , this is how I want my life to be run in terms of the DPC portion.


And this is the part of me that can do DPC slash community, and this is the part of me that does community based stuff. And that's on top of, you know, family and entrepreneurial stuff. So , it's been a great year, but the space really represents, I think the expansion of possibilities in the practice.


Yeah. But the space and the community, I mean, in general, the importance of you being there is, is huge, right? Cause you recently had, the boys were sick and I mean, you think about what was and wasn't available in your location. Luckily, you're a doctor, right? And you have the capability of knowing who to call, what to do, having meds there at the practice.


you know, what about all these families that they don't have doctors in their family? Oh, and you're the show in town, right? Absolutely. You and your husband. Yeah, this is true. But I mean, honestly, your importance , is huge in that space because it's such a drive to other locations.


, it, it really isn't, you know, it highlights the importance of physicians being able to practice , in a model.


So that they don't leave medicine and so the services aren't you know, eliminated completely, right? Because you are so right in that access to care these days, especially when, when, when we're rural is so, so imperative to the health of the community. And so, you know, for me What Amber was talking about was that the boys got sick and I actually had to take my youngest to the emergency room because he had ta kipp.


And you come to a point, at least for me, where I can't trust my doctor brain as a mom. And so, but yeah, I mean, I was texting , the peds hospitalist because I have his number and I just needed to get an x-ray. But even to get an x-ray, it was, , five hours later, could I have ultrasounded him?


Sure could I have done an RSV and a covid test because I have those rapid tests short. But he had never been sick before. Like he was a covid baby. And so he'd never practiced really getting sick before. And then this happened like three days into daycare for the very first time.


It was like, oh, there you go. Yeah. And you know, with you having the ability to help


families in their situation at your clinic and , have the tools that you do have Yeah. That's going to be huge in, in your smaller community.


Yeah.


I mean with that being said, even like when you were here in Nebraska and talking to other physicians through the podcast, is there anything that really prompts you to want to have available for services or even tools or medical equipment in your practice that you've really just kind of decided, okay, we need this here.


We have to have this even talking. Some of these conversations with the other physicians.


Yeah. And definitely that's been like, I, I think I alluded to it last year also, that like, I really would like to have a space to offer community services that are not, that are separate from my regular membership.


And so things like weekend circumcision, clinics, like literally just the availability , of a family to get to a clinic. It is a huge thing over here. And doing things like skin cancer screening dermatology procedures because people can't get access. I mean like basic things like that.


Like, flu clinic once a month or whatever it is. Those ideas are, definitely coming from one my community, but two, having talked to so many physicians about what they offer in their own communities, like Dr.


Vicki Borgia offers free sports physicals to her local, schools. Amen. Like, why can't all of us do that? Oh, wait, we can do whatever the heck we want now.


Yeah, yeah, yeah. Oh gosh. I know this Friday we're having a free p r p clinic for veterans for veterans Day.


And , you're exactly right. What you want to do, you can do. It's your clinic. And speaking of your clinic, balancing things, how has the last year been with the podcast? Really kind of exploding. It's, it's definitely completely different than it was a year and a half ago, a year ago. Right.


And now you have this clinic that you have to open and well not have to, but you are at a point where you want to, but the boys are growing. Right. And trying to balance that too. And what does the last year look like with the podcast and, and balancing all that, and what do you foresee it turning into after this


Great question. So I don't necessarily think the brick and mortar is adding in terms of time suck. I don't feel that at this point and clearly I just opened the office, but what I feel is that it can actually be helpful. Yeah. I, I, I was talking to, well, especially


with you're spending time driving to all those places, right?


Correct. So it definitely will add your time , in your bank there.


Yes, absolutely. And I was talking to a pediatrician who does exclusively home visits and she and I were talking about how doing home visits is definitely limiting her growth and. I can understand that and relate to that because it's like, I get that, you know, you can have, Dr.


Lon Burton has a great way of, in the DMV area that's the DC, Maryland, Virginia area that she has, you know, on this day I go to this area and, and while that's probably the best and smartest way to do things I tend to find myself spending longer at home visits and I've had to put boundaries to say, I have my watch now, it will go off in 45 minutes to alert me that when I'm talking and I'm in my doctor mode and I'm in my chatting mode, that I have to like, rein it in because I have to get going to the next person's house.


And so, that would not be good for me. . Yeah. I don't even know


how you do it.


Yeah, that would be, yeah, it's, it, it was definitely a, an exploration of boundaries for sure. Because I love my patients so much. It was just like, , I, I had one lady who she had a lot of concerns that were back to back and.


I was like, sure, I'll come over. And it was like, I thought it was gonna take half an hour. I really thought it was. But you know, you've never done anything in a half hour. Maybe a flu vaccine, but Okay. Okay. Okay. You got me there. Oh, man. But yeah, I mean, I by nature am someone who, like, who's doing a podcast.


I mean, I love talking to people, and so it's definitely been an exercise there. But learning exercise in terms of home visits are great for certain things. Like my patients who, you know, they, because of whatever reason, age, physical status mentation status, whatever it is, if they need a home visit, I still have the ability to do that service for them.


But for the people who. I don't mind coming to the office. Great. It saves them money on doing home visits cuz I do after a certain point, charge an extra fee for home visits. They can just come into the office and so just like your own office, there's no fees, fees, fees every time they come into the office.


In regards to, you know, balancing the podcast and the kids, it definitely helps to have care involved. Like it takes a village. Absolutely. And for me you know, having school for Asher and having daycare for Nolan, it's definitely helped , to free up time that I can really. Have a block of time to focus on things.


I just need to maximize on that time, which I'm working on. That's, I, that's why I feel I'm very Yeah, I hear you. But that's, but that's why I feel I'm very much in a sophomore stage rather than a freshman stage of all of this. Even though I've talked with so many positions, it's like in my own practice, I still feel, yep, I am in year two.


Right.


Do you feel like you may end up putting some walls around your practice volume because you really are enjoying just that chance to talk and inspire other people, other physicians? I mean, even the time you spend on stage at Hints Summit, you're inspiring people on the podcast on stage.


I have never been a full-time family physician after residency, nor do I intend to be because I do enjoy, I love doing this podcast. I love meeting people in person. I love being able to hang out with my kids and take them on vacation. Like, we finally did that for the first time in two and a half years, and Nolan went on his first plane ride.


Yeah, they, Hey, Henry Doley is coming up, man, I swear. But yeah, Nolan went on his first plane ride. It was just, it was just such an awesome year. And because of the way that my clinic has grown and the way that I've been able to, to learn my barriers and learn that, you know, I might not be at my barriers yet, or,


you haven't defined them yet necessarily. .


Yeah. But it helps me, I guess, get more clarity as to what boundaries I would be comfortable with. I, I do not envision my practice being, you know, 800 strong. And, and I will say that like, you know, there are definitely days, it's not all senti, lollipops and rainbows.


I, I had the great privilege of attending one of Dr. Sharon George's uh, retreats in Napa earlier this year. Oh, it was so awesome and just, you know, again, like being in this space with DPC physicians is so, like, there's no word to fully describe that experience. Right. You and I totally know what that, that feels like.


But, I had the privilege of talking to other physicians and I was privileged to hear stories where DBC is not the easiest thing all the time. And I'm like a hundred percent, like, I have had days absolutely where I'm on, you know, at the point. The tears are going cuz I'm super overwhelmed.


But just like Dr. Lauren Hughes shared in her uh, reunion podcast with Dr. Monko and Dr. Much that when she starts feeling irritated with what she knows that normally she's not irritated with. She, she feels that that's her. Like, oh, this, I'm approaching a boundary.


And for me it's like when I'm feeling stressed, when I'm feeling, overwhelmed, I am very grateful to also have this space to say like, okay, we gotta reevaluate what's going on here. And so that, I couldn't have that in fee for service for sure. But , all of the feels that I've experienced over the past year that my family has been through the past year it really has allowed me to say like, yep, I love doing the podcast. Absolutely wanna grow the podcast audience, the podcast.


Impact, but also I wanna grow my clinic to what I can handle and where I can make impacts where I couldn't make them before and be able to take care of people and be a mom and be an entrepreneur.


And , I have more tools under my belt in order to achieve those things.


you had mentioned something about adding on an extra fee of people have more than X, Y, and Z home visits. I mean, do you have that number set out or is it based upon each patient individually, or how do you do that for the people that are performing home visits or wanna want to do this and have a model similar to.


That's a great question. So when prior to opening the office, everybody got two home visits a year that were intended to be. One was an acute, like if somebody needed stitches and one was an annual home visit. And so that was the, per calendar year. And then on top of that, if somebody needed additional care at home, there was a fee for a hundred dollars plus, depending on how far you were from my location in Arnold.


In terms of how the model's going to change, I'm currently working on, you know, how to give as a very, very big thank you , to my initial adopters. This, continuation of. Like, I want to provide home visits for you guys. Whether that's one, whether that's two, whether that's, I don't know how many, I'm, I'm still working on my pricing going into 2023.


But in terms of, the thankfulness, I, I want to show them thanks for believing in this practice and understanding the model and joining early on. And then beyond that, the people who join the practice as of 2023 and going into the future, it'll be a different structure. And I, I feel that my ability to just say like, yep, this is how it is, and not have the, oh, but I don't wanna change the, the pricing, blah, blah.


Like, I feel that by hearing other people's stories, I have a lot different confidence and assertiveness when it comes to. Changing prices because that's how it is. Because now I have a physical space and I have more options for care with within the community that I can do that. And I don't feel, I don't feel guilty about it.


Well, and you have more overhead now, so obviously need to make that cost up for sure. Yep. What do you think about just procedures and having, if you do decide to stay with a smaller volume of patients procedures and keeping all your skills up, thinking like procedure clinics or kind of what you were mentioning with the circumcisions, doing things like that with dermatology and your skin io.


Exactly, yep. So my ideal for keeping up my procedural skills is to offer procedures for the community. So, what, whatever that, that need might be. I, I don't know what the need will be in terms of like, if the community college needs, you know, a women's health day where they just need pap smears and people aren't able to come until these hours, like working with working with a community to figure out what's the need in terms of procedures.


But yes, in terms of dermatology, in terms of circumcisions those are absolutely in that arena of, to keep my skills up, I wanna offer those services carved out of membership to the community, or, I mean, when you fly down to Nebraska


to keep your skills up as well.


I mean, just saying, Right.


Well, this is true. And for those listeners out there Amber and I were talking about, you know, how much does it cost to get malpractice and a license in the state of Nebraska, and how much does it cost for a ticket to fly out to Omaha? Mm-hmm. . And it's absolutely doable.


You know, if there's, I mean, just like how John Jacobson fls to your clinic to do vasectomies. Mm-hmm. , there's ways to make things happen if you have the time to, and you truly want something to happen, there are ways to think out of the box to envision that thing happening, whatever it is.


And so that could be procedures for some people that could be obstetrical care for some people. That could be whatever it is. But, you know, even the, even the physicians who are frequently posting about like, you know, I didn't do many XYZ procedure in residency. How do I learn these things? There's ways to learn procedures, there's ways to expand our knowledge in medicine all the time.


And, and in this model, I've really found that, again, like with everything I've described, that you can do whatever you want. ,


right, right. Yeah. No, I agree. I agree. That's true.


Yeah. So with you serving your community in Arnold, I mean, we have Ashlyn, my hometown, so it's a little over a thousand people, and then we're in Blair for 5,000. We have been able to add that same sort of medical care in Ashlyn. You know, for years they had a medical clinic and they always.


because it's a traditional clinic they can't afford. They have high overhead, you know, they aren't there long. So we foresee our DPC clinic staying there long term. And when we do that, then we're able to help anybody from people with insurance to without. But Ashlyn has a lot of blue collared community members.


And so for them, a lot of them aren't getting care at all unless it's affordable. So we've been able to provide anything from urgent care visits to IV fluids, to, you know, biopsies. It's really neat being able to help farmers in the community and, and doing everything these small clinics do. But as you know, our clinics in Ashland and Blair, we provide a lot of different services and still offer prenatal care.


And like you said, John will, Dr. Jacobson will fly in and do vasectomies and sometimes drive just depending on. The weather, but it's been very eyeopening to be able to provide those and then grow, right? So we're getting ready to go on year five and we have two places here in Blair and we have our clinic there in Ashland that we still drive down to once a week.


Hopefully, you know, getting to a point where we grow big enough in Ashlyn that we can add somebody there. So then they're they're more than just once per week. Maybe even have our nurse there five days a week, or a nurse there five days a week. Other than that we spend a lot of our time here in Blair.


There are a lot of people that seek care outside the traditional medical system in the hospital here, but also people that utilize both, both our hospital and our clinics. So we've just been really blessed to have grown as much as we have in the last few years. But when you were here, I mean, obviously you gotta see we're doing, you know, p r p prf, we're doing OB care, we're vasectomies, IV fluids, biopsies.


I mean, we keep everybody running. I mean, we, we probably see more patients per day than most DPC clinics do. But we have a, I'd say we're a little over a thousand people in our practice now, but we also offer aesthetics and like I said, quite a bit of like hormone therapy and consultations from that perspective.


So we have people driving in from Omaha people that drive in from outta state. So it's, it's just really fun to keep just a large variety of medical care available at our clinics.


Yeah, absolutely. . And yeah, it, it, I I would say that, you know, my 2 cents in terms of visiting another direct primary care physician's clinic or clinics in, in Amber's case I definitely would say, you know, go into it with an open mind in terms of you never know what you're gonna see.


And , just think about, okay, you know, in terms of my own practice, what of this practice can I learn from? And that's, you know, down to like for your clinic, you guys were describing how there was some difficulty with patients saying, oh, but I didn't know I was paying cash for the labs versus using my insurance for the labs.


And you have a very clear. My understanding is that I'm going to use my insurance or my understanding is I'm gonna pay cash for the labs. And that's a huge thing that I picked up on in terms of being able to, you know, just like a consent form, like to say like, this is how you're gonna pay for your labs.


Yeah. We


had to do that because it seemed as if no matter how many times we would explain to patients over and over, you know, that this is the extra cost that's going to be on top of your membership fee. Then they might say, oh, I didn't know that was gonna happen. Or maybe we would tell them what it would cost for the labs and then they would call back and say, oh, I had wanted to run that through insurance.


And it just puts you in a hard spot with , even your staff, cuz you know your staff is doing the right thing. You totally trust your staff. But it got to a point where it was happening too often because people would say they want one thing when they're in here and then they leave and they want another.


So we just decided, you know, like you said, we just made up a form that said, okay, I'm either choosing insurance or cash for labs and we check it, they sign off, they get a copy, we get a copy. and we found that for that, for the lab scenario was definitely something we wanted to do that on. And then we also show them our termination agreement when we have them sign a contract.


Because that was the other thing people really struggled with is they wanted to call up. On say the second or something and terminates, but they are due to pay on the fifth. Mm-hmm. . And so now here it's three days before they're due to pay and they want to cancel care, but then in a week from now they're gonna call and say, oh, can you refill something?


I guess I forgot, you know, I wanted this before I left. So we had them start signing a termination agreement too that just, they understood that they were going to pay 30 days past the time that they signed that form or stated they wanted to terminate care. I mean, those are the two things we're pretty hard on in regards to, okay, sign off on this, know what you're signing.


Because these, these two policies will stick. They are there, and, and those are things you learn over what, four years being.


Yeah. but I think that that's great, , knowledge an experience that you share and you, you know, you've shared on top of your, what you've shared on the podcast before with, our talk, and then also your initial interview.


And I think that those are the things that, it's like when you're at a person's clinic, when you're at like what they've envisioned and what they've created, it really allows you to just reflect on your own space in terms of if you have a future space. If you have a current space, and you know, in terms of like workflows, that, that's another thing asking the staff how do they do things?


How do they set things up? , and envisioning like, do you have the same amount of. Do you envision yourself hiring staff? How would your workflows work thinking out those scenarios? I think, I mean, it's just like having like a, like an osce back in medical school. You're really like doing your own mental osce as to, okay, would this work?


Do I like this? Oh, I wanna bring that into my clinic. Wouldn't wanna do that. Whatever it is. Mm-hmm. . But it, it, it makes you go through a mental activity that's very different than even hearing other people's stories. It's like, it, it, does reach that to an extent, but seeing, and like, you know, the, the number of feet that it takes to walk from your exam room to your office, like, I can envision that and making efficiency or creating efficiency where it can be created based on a physical space.


It's, it's just very different when you, I, I feel, when you look at somebody else's space. So I was, super grateful to, to have that time that we spent together. And I loved also that like , you've built this network , of different vendors. . Yeah, just


having different, different vendors for each different thing. I try and keep relationships. Just I, I'm definitely tied to keeping those relationships I've had originally not expanding them too much, try and to use things efficiently so I'm not having multiple orders from different places.


But there are things that we just have a better connection with some of our reps with, and so we have like three and four places that we get different services from, but we also offer a lot of different services. So, we don't just have our Henry Shine gpo like you were mentioning. You know, we have our, our custom pharmacies that we're getting things from too as well.


And then, like most people, they have their pharmaceutical reps coming by and da, da da. But yeah, I, I really value relationships with those individuals and that's how we've been able to have a successful clinic and grow. But man, definitely clinic flow and efficiency. That's something that we're always going back every day and, and really going through.


We have our monthly staff meetings. We try and discuss what can we change, what we, can we improve. Some of that we had to, because we just grew so fast when Matt came on board, our pa because now it wasn't just my patients, it was the patients. He was growing and the panel two. So I mean, we, we went from two nurses to, you know, now we have four and we have a receptionist and we have Matt.


And that all grew in like a year. We had a clinic lead for a while and she's now no longer with us. So I definitely would say HR is a lot of work, that's the thing I think people underestimate. Even Dr. Lasy and I have talked about that before. It's like, wow, I'm drained. From the amount of hr just mental work that you have to do.


And it's not always that it's bad hr, it's just that it's a lot of work trying to run the administration side of your clinic


as well. That's so true. And something that we haven't talked about is that I had a change in my own staffing. I was working with a particular virtual assistant company and I switched around August is when I started working with my new virtual assistant.


And and all


that time you have to, you know, put into


that, it's like the pain of switching an emr. I feel. I, thankfully, I haven't had to do that yet, but for me, switching to a virtual assistant and figuring out, it was very eyeopening for me to.


Really experience a difference between somebody who is not medically trained and somebody who is an rn, has been an RN for over, you know, 10 years bedside medicine and able to understand things medically or able to even have, have come from training specifically to be a medical virtual assistant. So I, I really, I'm, very, very blessed.


Dolan is the virtual assistant who came on board as an RN in August, and it's been wonderful to be working with her in such a different way. But it's also made me think about the workflows and like literally rebuilding from the ground up, different workflows because what I found too often my workflows there's too many steps to them.


And so for me, especially the way my brain works, . That's again, going back to that soor phase, I really feel it's like, okay, no matter how many stories I have listened to and how many people I've spoken with, man, going through it it definitely, it helps, it helps immensely to have those stories and those lessons behind you.


But then when you're actively dealing with the how am I going to fix this situation in particular, then that, again, I'm very grateful for the freedom to then be able to harness my own, what will work for me and then create, you know, the new workflow or whatever it is. But that's something that The rate of growth or my comfort with wanting to onboard a certain number of people per month, because I don't want to, I, I don't like the feeling of like, oh, I needed that, so now I gotta add that.


because it wasn't there before, but now that it's there, I don't have to go through that again. So, for example , I'd always wanted , a drip sort of campaign in terms of how to use the practice. Dr. Donna Gibbons had sent me her example of what she would do for her practice, and she used a, a CRM that had some kind of like recycling of the content in terms of you know, every so many weeks they, her patients would get a, an email about xyz, whether that be like how to send prescription requests or whatever it is.


But I really feel that those types of personalizations especially built off of your workflows can really continuously bring that value proposition and that relationship based aspect of your practice to your patients. And repurposing content within your own CRM is a huge win and it's a huge win for yourself in terms of future self. So that's one of the things that I'm working on going into two.


We just got, you know, we're finishing year four and just probably four or five months ago we sat down on a Friday afternoon for hours and. One of the nurses and I, Misty, she used to work with me back in the traditional system as well. And then Brooke, our receptionist, and anybody that had their hands in making any new forms . , we sat there for hours and double checked that everyone had the updated copies that were going in the front box in the front. And did I print off everything that I have? Because that's the other hard part, is that as you're creating these things throughout those years, you may have used one thing for a patient and then don't need it again for probably five months or something, and then you forgot that you made one.


So you have to go back and we had to sit there and customize all our content, make sure everybody's boxes and everything we're up to date with the newest form. Because not only are you maybe making things, you're also updating forms or maybe your staff changes, I think for sure. Paperwork. And even just like any consents and things like that, that is the.


Hardest part of just the administration HR side because there's just so many moving pieces. Mm-hmm. , and you also have people that have their own computers and you know, have their own inboxes of stuff. And just making sure people aren't hoarding things away, you know, and you don't know what they have. So it is very nice to have just you, being able to manage all that.


But for people that are running micro practices, and it may just be you, like that is the time to get all your ducks in a row. Because when you're at my stage and you have all these staff people, right, and things have changed, you have to make sure that people are using the right paperwork and you know, just making sure everything's updated.


So there are a lot of hands in the pot. You get this far and, yeah, I'd say that. That DPC graduation level of just going from that, like you said, freshman, sophomore, junior, senior. I mean, , they really do change, which is why for the d PCA in the summit, that we co-hosted with afp. Why we were trying to make sure they, when we were planning the summit Dr.


Laie and myself and , a handful of the other docs like Dr. Walsh, Dr. Forbush and Perel, you know, we are like, okay, how can we strategize and make this for sure something right outta the gate? But don't forget about all these people that are trying to keep ducks in a row, right? And grow their practice.


Make sure they run their practice. There are just a different sides of business administration on


that, but yeah, absolutely. And , the people choosing DPC already have. amazing ability to choose a different way that is not necessarily the mainstream yet.


And so then having that support, not only online, but then through that, the strategic curricula that you guys set forth for the summit was incredible. And I, I think that this year, especially with the track one, two, and three, it was even more effective at getting that, message out there, that it's like, yeah, there are people who have experienced it all and finding the people.


who are in similar stages to you or being able to choose to look at and hear and see other people's experiences, a couple years from where you are currently? it definitely, it's just, it's so powerful and, and I mean, you and I, it goes back to that being in the same space as another DPC physician.


It's like you and I are definitely huge. How can we help you type of people and whether that be patient care, DPC care, when, or dpc, you know, , inspiration when it comes to DPC itself. Just being able to, , do this type of chat and just being able to see if there's anything that can, that, just be based on our experiences, being able to have it out there so other people can say like, oh, I can totally relate to that, or learn from that.


Yeah, it's so great. And, for those people who were in attendance, I would say, , one of the things to think about during the winter holidays or whatever, especially for those people with kids in school, is think about like making time. If you have not to either watch for the first time or go back and re-watch those dpc summit videos from the summit in Kansas City.


Especially because the recordings um, you listen to them. in March of a year it will be very different than listening to them and June of the same year, because you might have added staff by that time or whatever. And so yeah, it's, it's, you guys did a great job and I will, you know, encourage people to look out for the next dates of all the DPC summits out there coming up in 2023.


Yeah. I think we're


just gonna continue to, , just blow this free market outta the water . I look forward to where all the DPC physicians are gonna take this in the years to come, because the passion that precedes all of this is, is huge. And that's what drives change, right. So I do think that all of us together are just gonna make a huge difference.


I, I've never seen people so motivated, you know? Absolutely.


Absolutely. And what a reason to be motivated around, right?


That's right. That's right. So cool. So cool. I, I absolutely love doing this year to year. This is our second year in a row to kinda catch up and I feel like we need to do this sooner than later a year is so much to try and cover. But just the progress , from, you know, last year to this year and heck, I was two clinics open now on three clinics open and I better not be five or six by the time we talk again next year.


And you um, hopefully will have multiple episodes out by the end of next year when we chat again, unless we decide to make it sooner. But I appreciate you having me on again, Dr. And out, out




*Transcript generated by AI so please forgive errors.

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