Direct Primary Care Doctor
Dr. Neil Panchal was born and raised in New Jersey, completed a 7-year accelerated BS/DO program with his Undergraduate Degree at SUNY New Paltz, and medical degree at the New York College of Osteopathic Medicine. After medical school, Dr. Neil completed his Emergency Medicine and Trauma residency training in New York City at Mount Sinai Beth Israel as well as rotating for Adult Trauma at Elmhurst Hospital in Queens, Pediatric Trauma at Jacobi Medical Center in the Bronx, & Pediatric ICU at Mount Sinai Medical Center in Manhattan. In his final year of residency, he served as the Administrative Chief Resident building his foundational passion for clinical operations, process improvement, and intersecting with healthcare technology. Since training 10 years ago, he has continued to practice Emergency Medicine across multiple geographies, and currently practices Emergency Medicine in the NJ/NY/CT area.
In the year of the 2020 COVID-19 pandemic, Dr. Neil founded Paging Dr. Neil, a house-call-based medical practice in northern New Jersey, initially providing in-home COVID testing and care, which has now evolved into primary and urgent care with at-home physician visits, mobile IV infusions, mobile blood draw and specimen collection, mobile ultrasound, and direct access to a doctor via phone, text messaging, or video consultation. As an Emergency Doctor, his goal is to keep people out of the ER.
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Direct Primary care is an innovative alternative path to insurance driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DP C story podcast, where.
You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Maryelle conception family physician, D P C, owner, and former fee for Service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct Primary care.
Direct Primary Care is an innovative healthcare delivery model with a doctor patient relationship at the heart of its motivation. Direct care provides freedom for patients to choose their doctor and freedom for doctors to practice medicine in the best interest of their patients. I used to have to say to my patients in the ER, the best way to reach me is call 9 1 1. Now I say, as your emergency medicine doctor, my goal is to keep you out of the ER. I'm Dr. Neil of Paging Dr. Neil, and this is my DPC story.
Dr. Neal Poncho is a board certified emergency medicine physician and D P C physician at paging Dr. Neal. He is known by most of his patients and colleagues as Dr. Neal. He was born and raised in New Jersey, completed a seven year accelerated B S D O program with his undergraduate degree at suny. And medical degree at the New York College of Osteopathic Medicine.
After medical school, Dr. Neil completed his emergency medicine and trauma residency training in New York City at Mount Sinai Beth Israel, as well as rotating for adult trauma at Elmhurst Hospital in Queens, pediatric trauma at Jacoby Medical Center in the Bronx and pediatric I ICU at Mount Sinai Medical Center in m.
In his final year of residency, he served as the administrative chief resident building his foundational passion for clinical operations process improvement intersecting with healthcare technology. Since training 10 years ago, he has continued to practice emergency medicine across multiple geographies and currently practices emergency medicine in the New Jersey, New York, Connecticut area.
In the year of the 2020 Covid 19 pandemic, Dr. Neil founded Paging Dr. A house call based medical practice in Northern New Jersey initially providing in-home covid testing and care, which has now evolved into primary and urgent care with at-home physician visits, mobile IV infusions, mobile blood draw, and specimen collection, mobile ultrasound, and direct access to a doctor via phone, text messaging, or video consultation.
As an emergency doctor, his goal is to keep people out of the er.
To the podcast, Dr. Panal.
Thanks for having
me. I know It's going to
be an awesome podcast. Just because of the fact that you are an ER trained physician like we've seen with Dr. Mitch Lee, Dr. Brian Ost, and other direct specialty care physicians who have gone into including primary care as part of their services.
Your training came from many, many places. And so when you look back on your journey in exclusively doing emergency medicine what was that journey like and how did it bring you to the point in 2020 when you opened your own clinic?
Yeah. Great question. And it's, it's usually the, the beginning of every conversation I have with prospective patient members as well as my colleagues to say, how did you get here, ? After residency in emergency medicine I worked full-time at the emergency medicine doctor in New Jersey where I'm from, at local emergency departments, urban, as well as suburban.
ERs and I, I did really enjoy the clinical aspect. I loved the bedside, loved that engagement with my patients. I loved helping people and still do in their most vulnerable times. But that was a lot of nights, a lot of weekends, a lot of holidays for several years. And I don't know if I was, but I, I think I was semi burned out after some time.
And it wasn't the time commitments to the practice of emergency medicine, rather, I think it came with all of. Administrative bureaucracy that comes with healthcare these days, especially working for corporate centers. There's a lot of metrics. There's a lot of time to this and time to that, and there's a lot of patient satisfaction metrics that are not really designed to, I think help patients, neither.
And, and unfortunately that was overtaking my ability to practice the way I enjoyed and the relationship I created with my patients. You know, a couple years into pri emergency medicine, I. I actually took a sabbatical with my wife. We took a couple months off of life here in the western world.
We went East and kind of took some time to just refind ourselves and press pause and say, what, what's next? How do we find passion again in in our careers, in our professional lives, and how do we love and enjoy what we're doing again, for fulfillment. That allowed me to come back in late 2018 and say I'm gonna start something that doesn't require so much of a commitment.
So I, I started working emergency medicine as locums tenants, and I traveled around in different states really for a search to say, Hey, Does emergency medicine look different outside of New Jersey? Maybe, maybe I'm, I'm narrow minded, maybe I'm limiting myself. So I spent almost 10, 11 months working in mountains of West Virginia.
I worked in Tennessee in Western Pennsylvania. And although very different demographics, very different geographies, healthcare systems, pathologies, extremely unique in each one of those areas. The underlying problem was the same. The common denominator I kept seeing was patients didn't have great access to their, you know, their doctors or their healthcare access, and that that forced them to resort to.
Emergency departments for basic level care that usually is not emergency level care. And we're happy to always help the patient identify Is this or is this not big, bad, or scary as like I like to call it? But a lot of it's not. And you know, the, the phrase I always cringe at, The patients used to say, I called the office and they said, just go to the er.
And that comes up over and over and over. And I said, there's, there's had to be a fundamental issue here, and I just couldn't get over it. So I was on a search for my own career satisfaction saying there's, there's gotta be something more. I tried lookup settings and I still do. I, I look for alternate roles in healthcare for myself.
Was it an mba? Was it a master's in medical management? Was it health technology? I even considered pharma at one point and I had learned about DPC very superficially along this, this search, and I just kept coming back to it. Strangely, I attended the DPC summit in, in 2018, and I was just so fueled by the energy at this conference by all the other doctors.
That it, it was just invigorating. So I said, I have to figure this out. I have to find how to make this work. Maybe this is my outlet. And, and, and lo and behold, in 2020, it absolutely was. It kind of all came together unfortunately in an, in a, in an inconvenient year for the rest of the world, but, Gave me the outlet of passion and compassion and my career satisfaction altogether.
So, that's, that's that journey from emergency medicine to current day dpc.
Incredible. And I just wanna ask here, because you talked about how you and your wife both went on sabbatical. Is she also in.
She's in healthcare. She's not a physician, she's a pharmacist by training. She's working on oncology products and, and really helping make impact in a different layer.
However, there's, there's a lot of the similarities that we face in our clinical side of healthcare, and we both just needed to take a pause and say, what are we doing with our careers? And are we finding joy at the end of the day?
So I wanna ask a question in regards to and notes, because like you mentioned, the administrative burdens, the demands, the metrics that are put on you no matter what type of physician you are. In terms of getting notes done did you have support with scribes? Did you think about that or need that when you transitioned to dpc?
Yeah, great question. I have had scribes in many of the facilities, I've worked in many of the emergency departments and, and a lot of them not I haven't been offered a scenario where you bring on your own personal scribe and I think it just might be a matter of people compliance and who's in the hospital and who's looking at patient information, et cetera. But it definitely helps your workflow if you have a seasoned scribe who knows your style of documenting Everybody documents differently.
However, they are extremely good at capturing the data that is needed for the healthcare system. And that includes, essentially, It's demanded by the insurance driven billables, right? So certain number of factors for the history or the HPI portion, certain number of physical exams for a certain number of.
Review of systems and the medical decision making, et cetera. So they're very good at making sure you match all of that, where you get to perform as a physician and do the doctoring part rather than think about how many questions did I actually ask and how many did I write down? So it's been variable in terms of the emergency departments I've worked in When I transitioned to direct primary.
I have a little bit of informatics background myself, so I love healthcare technology, and what that means is I get to nerd out on. How to make my workflow as efficient as possible. And that means figuring ways out, like, you know, AI and whatnot to say, how do I make my life easier? How do I get to be just doctor?
And then answer a couple of things to make sure I, I capture the data that I want. What's fun now is, and as I'm building our, my team in our practice is I get to tell them, don't worry about the things we're. Brainwashed to remember to document instead do what matters. My documentation includes all the basics, health, history, physical exam, all that stuff, and then what's this person's dog's name and who do they live with?
What kind of food do they like? And, you know, are they allergic to this, this and that? Like fun things that I want to remember when I actually visit somebody at home to say, oh, hey, it's, it's sushi, your dog. Hi sushi. How you doing? You know, like that's the fun part that I can describe on my documentation
I think that that's important for people who are like, oh, I need a scribe. I need a scribe. But the scribe. For the insurance-based healthcare system. So I love that you highlighted that specifically. Now, when you went to the 2018 D P C summit and you saw you, you drank the D P C Kool-Aid and you, you saw how a room of physicians can truly be excited about practicing medicine no no matter what of physician they are.
Your website says, Primary care shows you. So when you decided to continue down the path of D P C, how did you go from the point of, okay, this is something I really want to do to, I'm committing to this, and what steps did you take to make your dream start to come to fruition?
Yeah, sure. I think a lot of it first starts with internally realizing this is what you want to do, and, and saying, this is my goal now.
Once you create that goal, I, I was on, I was on the path. You outline it and you realize, how do I collect the information that I need in order to find the right steps? In order to build and develop and improve. It was, to me a lot of talking to people like you're doing right. It's learning people's stories and understanding that every DPC is different.
That's the first thing you learn at the DPC Summit is every DPC practice is different. None are the same. And that is actually. Because you didn't need to create a cookie cutter practice. And for emergency medicine trained physicians, I think that's uh, incredibly inviting to realize that I didn't have to master in primary care like our colleagues do.
I was able to still offer something that I'm comfortable with, something that I'm good at, that I have skills in, in a direct care model. and it's still a unique, innovative healthcare delivery model. And that, to me was really important to first understand. After 2018, I was that guy who took all the notes at the conference, said hi to every person every presenter afterwards, and after contact information, I called everybody.
I networked, I learned I met some incredible people who offered awesome, awesome guidance. And I took notes and I took notes and I, and I realized how I want to build it accordingly. That happened for two, yeah, two, three years until I actually put it on paper and I said, this is what it's going to look like.
I was fortunate that in 2020. Covid led me to Yale where I was invited to be part of the covid response team in emergency medicine. And I started practicing in Connecticut. One of the towns I worked in is a community hospital in Greenwich, Connecticut. Greenwich, Connecticut has lots of concierge medicine.
more than I've ever seen. And initially I was like, what? Why does every patient I, I'm discharging 92 year olds with syncope, which I never did in any other hospital center because the concierge doctor said, yeah, I'll just meet them at home tomorrow and we'll do a carotid and an echo and this and that.
And I'm like, Hmm, that's actually really good. That's awesome. And we're gonna minimize healthcare spending. We're gonna minimize costs, and we're gonna minimize adverse effects and potential complications for this 92 year old who doesn't need to be in a hospital, hopefully and the doctor's gonna take care of it.
How awesome is this care and that. I kept, I kept asking, how is this possible? And the, again, the answer was connection, the access to your doctor and somebody making the time to be available. So I searched more and more. And I realized that even though all of these practices in in its abundance were concierge as a label, they were all direct care models at its root versus what we're all learned or taught is concierge medicine builds insurance in addition to this retainer.
But all of these practices are, not all majority were just direct care models. And I said, This is doable. I met a colleague that I worked with in emergency medicine there who ends up being my mentor, Dr. Jan Zla, who has done this now five plus years. And he said, Neil, just do it. Just, just do it. This is the way to do it.
And he practices emergency medicine in addition to his flourishion practice now. And he said, this is an outlet for you to, again, find compassion and empathy in, in the care that you want. So. Research the interview process. People like Jason Larson and James Gower. Josh Schumers and Yolanda Tung all these people were there for me on the other end of the phone call Dr.
Iman v in New York City. They were just great. They were great. That's
awesome. I love that you mentioned Jason Larson. I, he needs to come onto the podcast of his father-in-law. He sure does. Talk about the whole practice in Washington. It just he was, he was somebody I met in 2019 at the Hint Summit and just like, you know, I, I can totally picture him just talking to you and anybody just like open book, open heart, open soul, wanting to help you know, get, get everybody strong in the movement.
So that's awesome. Now I
have to, if I may give him credit with the model that I have now. Is actually because of him. So again, on this DPC building or startup journey, I thought I had to have a brick and mortar phy like physical site. I thought I needed to have a sign outside and I needed to do all of this type of marketing and advertisement.
And it was 2020. New Jersey real estate is surprise just generally and nevermind the uncertainty we were in. And I spoke to him, I dunno what to do. And he said, fuck, you don't need a physical space. Go to people's houses and I said, come on, that doesn't work. And he said, just do it. It's easier. And lo and behold, it's now the foundation of our practice.
Love it and speaks to my heart cuz that's, that's how I opened my practice as well. And how the word of mouth spread in terms of access to the doctor who does house calls locally. So that, that is incredible. Now, when you got closer to opening day, how did you determine when you were gonna open and after doing all the networking and all the research, how ready did you.
Yeah. Not ready at all. I'll start that way. . What was unique for my startup is the services I offered actually wasn't primary care initially. So because it was covid, all these doctor's offices were closed. If you recall, there was no antigen testing. PCR were taking seven, 10 days. The result, and the only people that had actually.
Really interacted or specialists that I think that have interacted with Covid were hospital-based specialties. Right? Because only hospitals were open for a long time, emergency medicine, critical care hospital, hospitals or internists and anesthesia, because we were intubating, we were putting lines in, we were doing this and that.
And I got comfortable, although frightened with Covid, I was comfortable saying, I think I, I can help at least minimize people showing up to the hospital because that increased morbidity and mortality. We, we, we saw that correlation very early. So what I started doing instead of care, I saw an opportunity to say, let's just do testing.
People didn't know where to go and their, when they did find a test available, it took too long, almost near the end of their suggested quarantine time. It wasn't making good impact. So learning from the TPC model, which means direct care to not just patients, but direct relationships with your, I'll call them vendors, right?
Laboratories, radiology, pharmacies. We build, we build a network of. More efficiency, cost reduction, and just better care. So what I did is I found local labs and I said, what is your process for receiving specimens? Analyzing them, processing them, and returning results. And I learned about each different laboratories processes.
And I said, what if I physically brought the specimens to you, handed them over? Would that expedit? The results and they're like, we've never done that before, but that's a great idea. So literally in the time where people were processing PCR seven, 10 days, we were resulting them in 48 hours. So that caught wildfire.
I was doing 20, 25 house calls a day just to go and swab and test people. Help them say you're gonna be okay, or you are sick. You need to go to the hospital. And who better than an emergency doctor to tell you you need to go to the hospital? We became busy enough, thankfully to I had to build a team.
I had to ask for help. And I, I called around to a lot of my nurse emergency medicine colleagues. As well as home hospice nurse colleagues and I said, you guys are, you, you know how to work in the field. You know how to be on the road. If you gown up and I'll help you make sure you're protected, will you help me?
We were doing 50 to 75 house call visits a day for several months at a time, just covid swabs testing. That evolved to people asking more questions. Hey, doc. , can I take that? Hey Doc, can I not take that? What's the deal with NSAIDs? Apparently that's, you know, all these myths that we didn't know about then it was all uncertain and I said, there's an opportunity here to help people again.
So we created a covid care program. Two, we program virtual. I had taught them let's create, let's teach you how to monitor your vital side at home, blood pressure, heart rate, temperature, pulse, ox, do that at home. Send it to me twice a day. I will tell you you're doing okay. Or I will tell you, this looks like it's in the red zone now it's time for the hospital.
We tried our best at home. And that just like you said, word of mouth kept developing. I felt great. We, we did some fun things, meaning we helped people in such creative ways during this time, and. I was excited. I was doing fun things to help people.
And, and that was, that was the best. And that, of course evolved into primary care. Ultimately.
I love it. And it just, I, I see you just, you know, released from this. You have to do the metrics, you have to do the blah, blah. And you sought an opportunity and you had the.
You have the ability to take hold of that opportunity and, and own it. So I, I love that. When you had this, you know, this following of people who were like, oh, if you need a Covid test code, call Dr. Neil. He'll come to your house with doing 50 plus house calls a day to then incorporating that care, plus the two week follow up plus then primary care patients, how did you make that transition in terms of managing your time so that you were still able to give the quality and atte attention that each patient needed?
Yeah, and that's an excellent question. That comes back to, I think just like small business fundamentals and understanding how to grow a business and who can do what in terms of a skillset. We on her team had incredibly talented and still have incredibly talented team members.
Um, We're talking, these are nurses who are charged nurses for emergency departments who have gone on to do pediatric cardiology fellowships. In as a nurse and we have home hospice nurses, right? These are people who are extremely talented and I realized they can do a lot of the care that I can offer if I can help at least create guidance structure.
So at that that. Juncture, I had to separate what requires doctor level guidance and care and what was more ancillary care or, or, or nurse driven kind of care. And, and I gave full autonomy to my team and said, I trust you. You can do this if I tell you this person needs X, Y, and Z. And that's that juncture where it helps separate.
My involvement with my patients to say, I'm here to be your, your navigator. I'm here to be your quarterback, and when you need blood work, when you need covid testing, I'm gonna have my lab technician or my nurse come to your house and they can help you out with that.
When you were making the transition to incorporate primary care, going from a place. covid Focused care, having teammates ready with you, did you build on your workflows that you had already created, or did you have to shift your workflows because you're incorporating primary care into the mix?
I ask this because sometimes, you know, we have to pivot, but sometimes we're able to take advantage of what we've had experience with and build on that. And with your background in, in systematics, I wanted to ask that specif.
Yeah, an excellent question again. I think a little bit of both.
There was some translation in the sense of the technology, quite honestly is onboarding getting the scheduling completed on time, confirming appointments. Getting the right data from patients so that we can help execute that in an efficient manner. We don't have a back office. We didn't have somebody that can do all of this.
This was all just done electronically and I wanted it be automated so that we didn't have to have a, a human being doing that level of work. So that definitely extrapolated into the primary care aspect of saying, I can just continue doing the these process. However, the level of care is very different.
This is comprehensive primary care, which I'm offering. So it does require a lot more clinical aspect rather than just like scheduling and testing and dropping off at labs and following results. So the. The structure of that is different and the execution there is different too. So you do have to take a step back and say how do I offer a little bit more of a holistic, complete picture here to somebody and a better evaluation with longitudinal checkpoints rather than one time care
What does a home visit look like at paging Dr. Neal?
Yeah, sure. Very unique, much different than the traditional visit that you might get in the traditional healthcare system to start. Is that the patient's home or office?
A lot of my patients or practice members are busy professionals who say, I don't have time to even meet you at home. I'm in the middle of my workday. Can you meet me during my lunch slot or in between my meetings? Yeah, sure. We'll meet in the conference room. Let's get started. The visits are.
About an hour and a half, 90 minutes the initial visit. And we do a thorough medical history, a lifestyle history cuz that's important to understand who's in your life, what you're eating, how you're sleeping, things like that. We do a comprehensive physical exam and, and that comes with some cool technology.
We're using auto scopes to look inside your ear, but I'm connecting that to my iPad via Bluetooth and I'm showing you what the inside of your ear looks like. We have a smart weight scale that does more than just weight, but a lot more biometrics. We're doing lab draws during that initial visit.
Being an emergency medicine physician, I'm well trained in point-of-care ultrasound, so I'm also doing and bringing my own ultrasound machine with me to do an ultrasound during your initial visit. And we're doing screening of major organs, your gallbladder, your kidney, your heart we're taking a look at all of these things.
In addition, we're doing an EKG at home. So all of this is a lot more comprehensive. I believe that your traditional primary. Initial visit. And then from there on we've created an annual plan and we have multiple virtual check-ins. And I make appointments with you instead of you making appointments with me so that I can keep you accountable on your healthcare goals.
I love it and I think that that is an unspoken thing about direct primary care in that, yeah, the accessibility is there, but also the accessibility to, to have our responsibility going. In the patient direction is, is definitely something that patients don't expect. Like I had a, a reminder out to a person for their skin check and they're like, oh, I totally forgot about that.
Given that you had experienced so many different, states and practices and, and care centers, how did you take your training and decide on what EMR to use for your patients in your clinic?
Yeah, that, that was a big deal. I'll tell you the truth, I had actually, I have EMR implementation experience where I was a director of informatics for a entire health system and I, I, I helped them launch their medical record system for all emergency departments. So this was very close to my card and I was very picky.
Ultimately I needed a solution where I didn't want more than one platform. I wanted a single platform that offered me everything in one place. We, we work in an efficient model so that we don't have to log in four times to get this data, to get that data downloaded, uploaded again. I need, I needed it Integr.
Phone, video, text messaging, medical data, vital signs smart capability. Ultimately we chose Atlas MD for those reasons.
Gotcha. there is, I, I feel that in my practice there is a separation between the people who are inquiring.
and then the people who are actively members of your practice, how does that work workflow wise? When somebody from the general public is asking about paging Dr. Neil, and then how does that transition to your workflow when they onboard at your practice?
Yeah. That took a little tweaking and, but I'm very happy with where it is now, so I always felt that's important for patients to be able to interview. Their doctor, cause this is a long-term relationship we're looking for. And for that reason, I want to be available to them also. It's a unique model.
It's a different healthcare delivery model, so I want them to be in the know. I don't want them to have surprises. So I offer a free introduction type of call, and they're allowed to schedule that as a virtual appointment, a phone call, whichever way they prefer. And we spend, you know, 20 minutes, 30 minutes going back and forth.
I off let them know who I am, my background, my specialty, and what I can offer them, and vice versa. They tell me, this is what I'm looking for. These are my issues, and these are my burdens in the healthcare system. Is this the solution? And I hope it is. But I'm very honest with them to say, you know, I might be a very good fit for you, but I may not.
And if I'm not, I'm gonna direct you to the right person elsewhere. After there is a mutual connection, we send them the EMR onboarding as well as the, just the legal ease of saying, Hey, we're now we're entering a doctor patient agreement. Um, And that's. .
I think that it helps, it helps clean things up in terms of, again, that separation between the people who are exploring and interested in the practice, they're not yet committing.
So yeah, because you're not creating like dummy charts or whatever, right. Um, just to, to access their. You know, email and contact information that you need when you schedule a meet and greet. So I think that's awesome,
and that's an important part, especially in terms of privacy in today's world, is I want to respect everyone's privacy and if they're entering all this person information, there's a responsibility there.
Now I wanna ask about the. Fee structure at your practice because you have different levels of care for different groups of people. You have care for individuals, you have your covid care program in addition to concierge program, and you also have care for employers. How did you develop your pricing structure and has it changed over.
has changed. And that just came with the evolution of the services we offered. Initially there were one time, you know, covid testing visits that became Covid Care program. So that was a virtual two week model. And then as we introduced primary care and then further even one time Urgent Care House call visit.
All of that changed. So our fee for the main vein, which is primary care of concierge medicine as we call it is an annual basis. And, and the reason behind that is I tell people I want to talk about numbers related to your health, and that's it, . So let's set this up and let's not talk about it again for another year.
So we, we do that on an annual basis. We do offer a monthly for individuals. With a minimum three months commitment. And that helps a sector of patients that I really love serving is those coming from abroad. I think those that live abroad that are visiting for several months don't have any options here.
In the western world, they're in the US healthcare system and they're lost. And a lot of times they carry a lot of comorbidities. They need medications, they need labs. So We really created the monthly option for them, but obviously opening it up to anyone else who says, I just want to try this out. And maybe I'll join as a annual member eventually.
So our travelers get to choose definitely the, the, the monthly package for our employers. We offer the flexibility of the monthly just because they might have turnover. And I want them to have the option of changing again with that three month minimum. And then the other service is they're one time, and I think this is a little unique to not my practice, but a smaller.
Portion of direct primary care practices to offer one time services. And I'm open to it because it allows the community to, to really receive the quality of care that you offer and and to get a taste of how awesome this is. And then say, Hey, you know what? This looks pretty cool. Somebody just came to my house and I didn't leave , and everything is just happening and this is gonna be great.
How was your initial flow of patients once you transitioned to including primary care with your services?
Yeah, it had been, and it still is fairly gradual, right? I don't have the advantage, like most primary care doctors who are coming from an established practice to say, come with me. We're starting from the ground up and, and we're meeting patients for the first time, talk for them, this type of healthcare.
So it's gradual. It's at the pace that I want it to be because I do wanna offer really high quality care, and I don't want. Healthcare has become as a numbers gain and I, and I felt like there's attrition in quality once you start accelerating too fast. So it's been a really smooth adoption. I'm happy with it.
What it allows me to also do, so I still practice emergency medicine, so it allows me to have my feet in, in both situations and gradually test aile to say, I love both. I'm having fun doing both and, and where do I, you know, time manage and take it from there.
Love it. And in terms of employer groups, how did you come to onboard your first employer group?
Did they find you, did you find them?
I found them, you know, employer groups takes time because you have to reach out to them. You have to explain to them how this model is unique it, how it could be beneficial to them. It's a cultural change all around, whether it's employers or individuals, to understand that there's a different style of healthcare offered here and, and once you do, show them how it's beneficial to them.
I'll tell you most. Want to do good by their employees. They want to offer good care. They want them to be healthy. They just don't have many options because business health insurance is costly. And if it's not mandated, they're, they're having a trouble affording it for their employees, and that just costs.
The health of their employees, which includes a cost of retention, productivity recruitment all around, right? All of the, of the business metrics that people look at. So once you explained it to them in their language as a business owner, it, it's much easier.
How, what is your mix of patients like in terms of how many patients do you have signed up under their employer versus how many retail or individual patients have signed onto your practice?
Yeah. I would put more in a percentage, about 80% are individuals and 20% are employer groups or employees of those groups.
We're looking to grow that because I, I, I do think there's a greater impact and we can offer to employer groups. So, that will gradually evolve, hopefully in the next couple of
years. Awesome. And when you were mentioning, you know, how. Go from reaching out to an employer and showing them the value proposition.
In addition to pricing, , what verbiage do you use to show them the value proposition? When it's a fairly new model for businesses to.
Yeah. I think it's similar to the conversation with individuals as well, is to help them understand that what you're offering them is not insurance. You're offering them actual healthcare and access to a doctor conversation, consultation and that's a big difference that most people don't see.
When we think health insurance, we for some reason also just download that. We're also getting a doctor out of it. No, you still have to find your doctor. Once you have health insurance, you still pay outta your pocket. And there's fees and, and all this that comes with it. And you don't realize you don't actually have a connection or a relationship with a doctor unfortunately, a lot of people don't.
So once you start explaining to them that this is a direct relationship, that we are here to help you have healthier employees and in healthier business it relates in, in, in a understandable, digestible manner.
So, so amazing. I think that's really helpful for people to hear, especially those people who are going into the employer space or wanting to go into the employer space. You talk about how amazing direct primary care is and it just comes naturally. Like you don't even realize that the magic is coming out of your mouth when you're like, oh my gosh, I do this.
Yeah. And then I feel that that over time also helps make it easier for when people are determining their pricing and determining. , it's a new year. The pricing is gonna go up because their services are so awesome and they've heard themselves talk about them so many times, right? Whether you're talking to a person, employing a bunch of people or a single person, right?
So I think that's such a valid way to represent how to talk to employers versus an individual. In regards to the fact that you are an ER trained physician, I wanna ask about when you have been networking, have you talked with other ER physicians, and what has the conversation been like in regards to, concerns about how do I do primary care when I'm an ER trained physician as well?
Or what have you found helps inspire them or helps break that barrier so that they pursue D P C as.
Okay. It's, it was definitely a barrier for myself, so I, I can speak to it firsthand in the sense that primary care is its own respectable specialty, and you can't just pick it up in a couple of days.
You have to practice this for years. You guys are going through training for years and years and years, and that's why you're good. So I will never say that I'm a specialist in primary care, but I'm learning to offer that level of care to individuals. With my emergency medicine background. I think we're as emergency medicine specialists in a unique position because we know a little bit about a lot.
and that helps us navigate the system really well. And that helps us say we can learn this piece of information and then learn the rest of it as well, because we know enough to just get started. I think a lot of other specialists might have a harder time transcending into primary care for that main reason.
But the one thing I'll say to my emergency medicine colleagues is the, not just direct primary care, but direct care in general is so amazing that you can offer something that you're comfortable with, learn what you're good at, and one, recognize that what you're good at is very unique. So if you actually create a service out of that, for example, we do a household based urgent care visit, right?
There are a lot of urgent cares out there. Emergency medicine doctors do urgent care day in and day out however, if you offer that in a different center in a different place than someone's home, now it's all of a sudden unique again and you're doing what you're already comfortable with.
So that's the idea, is to dissect some of your skillset and create services out of those. And that's what I'm trying to do. Is to say I can help people with urgent care. We're doing home IVs cause I can throw a line in anybody and, and get that going. But we're helping people stay out of the emergency department for those reasons, even if it's a mild gastro and they've been out for days and they just need a little bit of normal sailing fine.
Don't sit in a three hour waiting room for that because of what reason. Right? Somebody with hyperemesis, that poor pregnant woman does not need to sit in a waiting room or an emergency department. We will come to you. We will give you an anti-nausea medication. We'll give you hydration. And we'll let you stay home with your two other kids.
You can't leave the house. I mean, , those are the people and the impact we wanna make
and not put them in bankruptcy at while you're absolutely giving them this incredible care. I don't remember if I had shared this last season, but , we paid over a thousand dollars for my kid to get a shot of Deron.
And then it was like, okay, I'm gonna buy Decadron now to have that on hand if he gets creep or whatever. Yeah. Right. And it was like, yep. Two weeks later, miraculously for less than $20, he was good to go. So, you know, that's, that's a, that's a thing that as as a, an ER trained physician that is incredible access to somebody who can really say, No, this is an acute thing.
You cannot be managing this at home and to be getting that care at your home. Just incredible. Just incredible. Yeah. What are the goals that you see for your practice in, in the future?
I think a lot of it is just the same, which is the gradual advancement and development of our practice. I think in the last. Year and a half. Thankfully, we have finally created the foundation of the primary care aspect of our practice, and now we're entering the small business and employer space is where we want to accelerate a lot more.
And additionally add more unique services, right, to help people stay out of the hospital. So that's fun and creative for me to come up with cross improvement and clinical operations uh, protocols. That's what I like to do. And, and do something innovative.
Amazing. And your patients will continue to benefit from all of the, the passion and care and attention that you pay to your practice. practice. So thank you so much Dr. Neal for joining us today.
My absolute pleasure.
Next week look forward to hearing from Dr. Somodi of Celeste Brain Health, an online migraine and neurology clinic serving Texas and North Carolina. 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 DP C.
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*Transcript generated by AI so please forgive errors.