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Episode 118: Dr. Esther Khatibi (She/Her) of New Life Direct Primary Care - Corpus Christi, TX

Updated: Apr 8, 2023

Direct Primary Care Doctor

Dr. Furey is Founder and Owner of North Star Primary Care
Dr. Esther Khatibi of New Life Direct Primary Care

Dr. Esther Khatibi is a Certified Family Medicine, Obstetrics and Women's Health physician practicing in Corpus Christi, Texas. She attended medical school at Southern Illinois University. Received her Master's in Global Health at Trinity College in Dublin, and she completed her family medicine residency and a fellowship in Surgical Obstetrics and Women's Health in Corpus Christi, Texas

Dr. Khatibi opened New Life Direct Primary Care, officially, in July 2020, and believes that excellent healthcare should be available to all. She believes all medical professionals should have the freedom to take care of their patients one visit at a time without fear of them being charged for more visits. With a great passion for the underserved, international patients, and women’s health, she has worked with the Corpus Christi Family Medicine Residency Program for 5 years actively teaching new physicians and has now been named the Fellowship Director.

In today's episode, Dr. Khatibi shares how experiencing healthcare in Dominican Republic, Haiti, Ireland, and Iran, exposed her to the shortcomings of the American healthcare system. Through her DPC, New Life Direct Primary Care, she has managed to integrate her love for family medicine, Obstetrics and teaching into her practice. From making the leap to DPC after working in medical administration and feeling the patients frustrations with the system, Dr. Khatibi started out with zero patients, to now having a thriving practice!


New Life DPC WEBSITE: HERE - Dr. Khatibi's non-profit

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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 DPC Story podcast, where each week 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.

I'm your host, Marielle Consumption family physician, DPC 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, DPC is everything I ever dreamed of, and it is the best career choice I've ever made.

Uh, Dr. Esther Kati of New Life Direct Primary Care, and this is my D P C story.

Dr. Esther Kabi, a family medicine physician, has a passion for obstetrics and women's health. She attended Southern Illinois University for Medical School, Trinity College in Dublin, Ireland for her Master's in Global Health, and she completed her family medicine residency and a fellowship in surgical obstetrics and women's health in Corpus Christi, Texas, where she currently works.

She joined the D P C movement in July of 2020 when she opened her. New Life, direct Primary Care.

Welcome to the podcast, Dr. Kati. Thank you. So happy to be here. I I am, I am super stoked because we were chatting a little bit before we started recording, but, um, today's questions are really, really highlighting the fact that you are a family medicine doctor who is practicing actively obstetrics and gynecology, including deliveries and c-sections and obviously, um, high risk prenatal care.

So I, I want to. Make sure that the audience knows that the the line of questions is definitely gonna go there, because very often we see people asking, can you do ob, can you do deliveries in D P C? And I'm so excited for them to hear your answers. Yes, I am very happy to be here. I love everything. Women's health.

I love obstetrics. So bring on the questions for those listeners who have questions afterwards. I'm always available, so just reach out to me. Love it. And just, uh, in case I forget, I just wanna point out that Dr. Kabi will be a featured speaker at this year's DP C Summit in Minnesota. So, uh, make sure that you check out the my DPC resources page and you can find the link to the DPC Summit that's gonna happen in June of this year.

Awesome. Yes, I'll be talking about gynecology and at your cervix. So excited to talk about women's health there. Hope you all can join us. Perfect. So when you introduced yourself, your practice is new life direct primary care, and I wanted to delve into your life pre-new life, direct primary care, because, um, one of the things that.

Really was, was so it, it really dumbfounded me was that the fact was the fact that you did not have medical insurance yourself until you were in college. And so can you give us a little bit of your history as a patient without insurance and how that affected your choice to go into your master's of public health and your choice into becoming a family physician?

Sure. Yeah. Uh, kinda. Uh, funny story, I'll, I'll share with you all that. Um, I remember being in, well, I'm the youngest of six kids. Uh, my parents divorced when I was young, so single mom taking care of six kids. I'm not sure why we didn't have insurance or Medicaid or something, but I just know that we didn't.

And, um, eighth grade, I was like 13 years old. We went to a church summer camp and, um, They had a halfpipe for skateboarding. Um, and I was into skateboarding. I wasn't good at it, but I was into it. And, um, they had, yeah, this nine foot halfpipe and I being the daredevil I was at the time, I was like, everyone else was too scared.

And I was like, I'm gonna do it. I'm gonna do it. I got this. And I get up there and my sister was there and she was the smarter one and said, maybe you should put a helmet on. So I put a helmet on and, uh, dropped into this halfpipe. Crashed terribly. And thankfully I was wearing the helmet though, and I hit the back of my head really hard.

And um, a bunch of people came over and they were like, are you okay? Are you okay? And I was like, yeah, yeah, I'm fine. And I was laughing. Most people who know me, I laugh when I'm happy, sad, scared, everything. So I was laughing and I was like, yeah, I'm fine. Um, and then I was like, but who are you guys? And they were like, quit joking.

Then I was like, no, I'm not joking. Who are you? And where am I? And I had no idea where I was. I was like having a little panic at the moment. And, uh, my sister came over and I recognized her, but I did not recognize anybody else. And they were like, uh, they took me to my room and they were trying to show me my stuff.

And I was like, it's not my stuff. Like, I don't know, it's kind of freaking out. And then they're like, okay, we're gonna take you to the youth pastor and, and see what they say. And I just remember as we were walking there, my sister whispered my ear and she's like, you better not be. Because you know, we don't have insurance and mom's gonna kill you if you end up going to the er.

And I was like, despite the situation, I was like, she's right. My mom will kill me. Like, and being a mom now I know my mom wouldn't have killed me, but it was the whole pressure of not having insurance and having a big bill. And so I just was like, okay, I'm fine. I'm fine. Um, and. I never went to the hospital and ev thankfully everything turned out fine.

But just that feeling, and I know so many people have that are in that situation where they don't have insurance, they don't know where to go, they don't know what to do. Um, and I love to cater to those patients because I know I've been in that situation, you know, even at a young age, uh, it's just not having insurance and not knowing like, is this something where I need to go to the hospital or I don't.

On my patients. I'm like, just call me if you think that you need to go to the hospital, just call me. Like, I'll tell you. So, um, so yes, not having insurance, um, as a child and, you know, being 13 and, and being worried about how much something was gonna cost. Um, so I know the adults out there. I know, you know, people who are less fortunate have the same situation.

And, um, same thing with with kids who don't have insurance. Kids out there who don't qualify for Medicaid or, or something. So I love to care of those patients. That's awesome. And you know, I think about how we're at the end of the pandemic and. Millions of people are losing health insurance that was covered during the pandemic.

So it's a very timely conversation that we're talking about, um, your, your history and your patient population that you love to take care of. So with that said, you also went to Dublin for a Master's in public Health to learn how. Healthcare was managed and operating in other countries. So can you tell us about your experience there and what real, what, what big lessons did you take home with you when you, uh, decided to go to medical school?

Yeah, so I, I went and did that master's program actually between my third and fourth year of medical school. So, um, I, it was quite a change from, you know, doing rotations to. It's just completely different life, lifestyle there. And um, uh, the group that was there because it was a, a program for, um, global Health was people from all different countries.

Um, so we got to hear from all of them and then we all had to go and do a research project in a different country. And so, um, it was, I mean, it's eye-opening how other people feel. American healthcare and their ideas, their expectations that we have the best healthcare and everybody has healthcare here and, and how we have so many options and so many medications and, and to some degree that is true about having more options and medications and maybe those things, but it's still not available to everybody.

And, um, I don't know. I think sometimes it's, they had no idea of what healthcare in America was like. And I've, I've done healthcare in Dominican Republic, in Haiti, in Ireland, uh, some, you know, uh, working with the healthcare system there actually in Iran. Um, during medical school I did a, or during residency I did a rotation in Iran for, with an ob gyn.

So I've been able to see a lot of healthcare in different countries and, uh, surprisingly I would have to say, Even though people think the American health system is the best, uh, we have a long way to go. So definitely agree with you there, and definitely that's, that's why we're here, you know? Mm-hmm.

Joining this movement left and right, physicians, that's, that's why we, we are here and why we see so many physicians joining this movement left and right. So let me ask you, there you are a family medicine doctor again who practices obstetrics and gynecology, and so. You were in medical school or residency, when did you decide that that was the route you were gonna take?

Um, I think probably my first year of, of medical school I worked with an obgyn. An obgyn and um, we each had a mentor and so my mentor was an obgyn and I just loved it from the beginning. And then I. I kind of just, you know, like a typical family medicine, you love everything kind of thing. I'm one of those people, so, yeah.

Um, I knew I didn't wanna just be an ob gyn and I have to say the struggle was real for family medicine to do OB because you don't really fit in this group or that group necessarily, but, But I did know that I, I, I think I wanted to do the family medicine route with OB rather than just be an ob gyn. And I don't know, it turned out really well for me and I love that I do family medicine and ob so it's so awesome.

It is absolutely awesome. And, um, after you graduated residency, um, did you do a specific fellowship and where did you do your fellow? Yeah. So, um, I did my, uh, we have an obstetrics, um, surgical, obstetrics and women's health fellowship at the residency program that I applied to. So all of the residency programs that I applied to, I specifically looked for ones that had either a high OB numbers or, or the possibility to do a, um, fellowship.

Uh, Part of the reason why I picked this location also, I mean, Corpus Christi, you don't get closer to a border than, than here probably, I think there's one other residency a little bit closer to Mexico than here. Um, I do speak Spanish, so I knew I wanted to use it and I wanted to work with the underserved and undocumented, so I kind of thought this was the best program to pick.

I'm happy I came here. Um, I did do the fellowship, and then I went on to become the fellowship director for the program. Um, so I think it's a great program. Awesome. And for those people who, you know, you, you've, you've peaked their interest talking about, looking specifically for residencies that had an OB track attached to them.

Mm-hmm. Um, or a fellowship. What words of advice would you have for those people in regards to if they are looking for that, um, that type of situation? Uh, depending on, you know, well, I'll just leave it there. I was thinking my mind is going a million miles an hour. Um, so what, what words of wisdom would you have for those people who might be looking for similar programs in the future?

Yes. Um, I would say definitely look for a program that has obstetrics, that is unopposed as far as the OB because that can be very challenging when they have an OB residency as well. Um, yes, you can learn a lot from them, but for family medicine, a lot of times, uh, people who do O B R rural, so though you're going to be on your own, so it's better if you learn from.

Uh, family medicine, ob, and from OBGYNs. I think, uh, picking a program that has a fellowship tied to it is probably the best because, um, e even being a fellowship director, we tend to pick from our own program before we go outside the program because those people are already aware of what patients you're dealing with, what systems you're using.

Um, and nowadays, um, I would pick some, a program that has. Some kind of curriculum with, uh, ultrasound. So, um, I think that would be very helpful for anybody who wants to do obstetrics is to have that training in ultrasound, so. Awesome. And you mentioned that you were the fellowship director. Mm-hmm. So I wanna ask you about what was your life like leading up to deciding and explore well before leading up to exploring and then deciding that you were going to do d p.

Um, yeah, so I worked in academics. Um, anybody who's been in academics knows it's a, it's a lot. Um, I had been a teacher actually prior to medical school, so I taught E S L and j e d classes and I think it trained me well for working with residents. Um, And, um, you know, it, it's a, a lot of work. Um, there's a lot of paperwork, there's a lot of politics when you deal with academics medicine.

Um, so I love the people I work with. I love the program director, but sometimes the politics and, and the drama within a program can really get to you. And I felt like I was just, you know that feeling when you open your eyes in the morning and you're like, I don't wanna go to. Um, and I have to say since I've started Direct Primary Care, I never had that feeling.

And I know like, I'm like, no, there's gotta be like, even like a bad day is still like a great day. Um, so I don't know. So prior to D P C, I mean, I just kept going and kept going. And even though I loved what I did, it's like you don't have enough time with it. And same thing with the patient care. Um, we have 36 residents in that, uh, residency program and just all of the administrative responsibilities.

I felt like I was getting further and further away from my patients. Um, I started giving everybody my cell phone number because they said they couldn't get through in the office. They were on the phone for 30 minutes. Um, some of them were pregnant and then I was very concerned like, I'm gonna miss something, or whatever.

So everybody had my phone number. I scheduled their appointments. I scheduled, uh, talked to them after hours, like I was doing direct primary care in a fee for, uh, fee for service schedule, like, um, or practice, or whatever you wanna call it. So I was like, what is the point? Why don't I just go to direct primary care?

I feel like I'm doing it already and I feel like I, I wanna be in control of my office and I wanna be in control of my life. And, and so I kind of just jumped and I, I think I wouldn't have jumped as quickly as I did if, um, I also worked at a family planning clinic where I did their leaps and I did their couples and, and those things, and somebody I worked with.

She had asked about coming and working with me, and then she called and said, uh, I'm quit my job and I'm coming to work with you. And I'm like, oh my goodness, I'm not ready. I'm not ready. Like I know I said I was gonna open this direct primary care, but I'm not ready. Uh, I was like, gimme a few weeks. And I was like, looking back, I was like, why didn't I say a few weeks?

I should said a few months. But, and she was like, okay, just a few weeks. And I was like, okay. And she was really good. And it was like, It's the best blessing that ever happened to me because I was kind of forced to do it quickly. Um, but I kind of just said, okay, I'm gonna get my notice. I ended up working an extra year with the program, but I worked, uh, Tuesdays and Thursdays, and then I did my practice direct memory care on Monday, Wednesday, Friday.

So, uh, but if she had told me, hadn't told me that she. Or that she was quitting. I think I would've probably organized everything and had it so perfectly ready, but probably would've been like five years later. So, well, there's nothing like ripping off the bandaid, so. Yeah. Yeah. Oh my goodness. So let me take a step back though there, because you are, are talking about how you transitioned quickly, and I definitely wanna get into that whirlwind.

Mm-hmm. Um, but when, how early in your career did you hear about direct primary? Uh, so I had a resident who was actually interested in direct primary care, so a shout out to Dr. Vo at first Primary Care in Houston. Um, and she was in her third year and she kept talking to me about direct primary care. And it funny cause I like, come office, tell me this again, need to hear like, do you think it's for real?

Like, does this work? And then she's like, yeah, and I'm gonna go do it. And I was like, ok, you go do it and then keep in contact with me. Lemme know how it. And I talk to her a lot. So, and she's doing great. They're all doing great over there. And, um, I think, yeah, it was probably like a year after she left, uh, we decided to go to, um, one of the first, uh, I don't know what year that was, the direct primary care conference.

So we went together and like we were just blah, blah, blah the whole time. Like, and I was like, that's it. Like I'm doing this. Um, From a residence. So, and now she's killing it over in Houston. And uh, yeah. And because of her I was like, but it was just funny cause I think I had, she had to explain it to me several times, so I was like, so wait.

Yes. So I love that. And, you know, for, for those people who, um, have not heard the, the story that has been shared by Dr. Kate Snodgrass and Dr. Gitu Goyle, um, take a listen to those episodes because where Dr. TiVo works is first primary care and, uh, I, I have asked you to be on the podcast and she will be.

But I am so glad that you sh you dropped a shout out because I love how. We are all connected in this, in this community that's growing, but that's such a cool connection. Mm-hmm. So let me ask you aga, again about this whirlwind because you had weeks and not months or years to open. How did you prioritize and get help with or get assistance with opening up your D P C?

Well, I have to say I, I started with zero patients, which I know is not a typical thing people are doing now. I think there's a lot more information out there about primary care. A lot of people have shared their experiences, hopefully, so that people have ideas about how to, you know, feel a little more prepared than I was.

Um, I also was quite worried about a non-compete, um, with my contract. So I was a little bit scared to tell my patients or have them like pre-enroll because I thought it was gonna be an issue. So I kind of was like, oh, I'm waiting, I'm waiting, I'm waiting. And then I was like, what was the point? Um, I should have just told everybody anyway.

But, um, so I think I, I started with pretty much nothing, no patience and um, kind of worked its way out. I. I don't know. We made it, we're doing well now, so that's awesome. And in terms of looking back, did you, did you start by finding a clinic space? Did you start by finding, um, your technology that you used for your clinic?

What did you start with to, to get the ball rolling? Uh, for me, so I knew I wanted to do ob. Um, so with OB it's important to be close to your delivering place because you can get called out of clinic or, you know, you might have to run and check on a, a patient. Um, so there's a building attached to the hospital and I just started walking the floor.

There's six floors, and I was like, which office is open? Or somebody's not using it. And then I called. I was like, oh my goodness, I can't afford this place. It's too expensive. So then I started looking for people who had like part-time hours for the week so that I could contact them about subleasing. I tried, I contact a few people and then I realized there was a neonatologist, uh, who I knew from the hospital, and, uh, they.

Don't actually use their office other than just office space. But they weren't like seeing patients. All their work is, they're hospitalists. Um, so they just see their patients in the hospital. So I was like, okay, let me go ask them. And I have never been a business person, so I like knocked on their, his door and I was like, oh yeah, I wanted to ask you a question.

And there was someone else in the room. He was like, yeah, go on. And I was like, um, So you have some office space next door and I wanted to know if I could lease it or sublease it and I could feel my face getting like so red, like, oh my goodness. And then he was like, yeah, that sounds like a good idea.

I'll talk to my partner and then boom, they were like, yeah, this is great. We'd love to, you know, do this. They gave me like, I think the first month or two free rent. So they were super nice, super kind. They don't have any, um, never said anything about how we used the office space or anything. So, um, that was a real blessing.

And once we had the space, uh, I think that's when I told, uh, Velma, the lady who works with me, and then she's like, okay, I'm quit my job. And I was like, oh my goodness, no, it's not yet. We have this space, but uh, I'm not ready. And then she's like, well, I have a few weeks or something. So I was like, oh gosh.

Okay. Here we go. Oh man. So when you talk about your space, can you describe for the listeners, what does your physical space look like and how do you use it? Sure. Yeah. Um, so one good thing is they already had some furniture in it. Like they had some couches, um, a few desks and, uh, a refrigerator, a table.

So, um, at first, um, I told them, oh, I just need one exam room, so I'm just starting. So they had three offices, um, like a, uh, break room area, a front desk area, and then one extra. Um, and then a supply closet. Um, and uh, at first I was like, oh, I just need the one room. And he was like, okay, well if you ever decide that you need the other office, just let me know cuz he had a desk in there and did some stuff.

So I was like, okay, no, we're fine. And uh, so we started out with one exam room, um, and then one room we made into a lab. And none of these rooms are, are large by any means. So, um, and then. I used one for an office, and then we just used that little like, uh, break area room. Uh, and so, and then little by little we've kind of asked him, we asked him for his office and I turned the supply closet into my office and we made another room.

And then, He had one room left, but he has some workout stuff in there for when he's on call and we put a little desk on one side of that room. So slowly, slowly, we like creeped into all of his space, but they've been very nice about it. And it was good that it was bigger than, than what I had expectations for.

You know, just having one exam room did work for a long time, but having two is a lot better. So. Awesome. And so in terms of you incorporating obstetrics into your practice, can you tell us about how you went from the dream, the goal, and the intention of incorporating obstetrics into your D P C, to developing, you know, how you price.

Obstetrical care at your practice or how you go about taking care of your patients who are pregnant, um, during, as well as after their pregnancy. Mm-hmm. So we, uh, it was very challenging. There's not a lot of, even within direct primary care people doing ob, but I pretty sure I've reached out to everybody who does OB with Direct Primary Care, um, to ask them about how they did their pricing, how they did.

Like what services they offered. Um, then I did a monthly fee for them. Same as like direct primary care. I don't charge any delivery fee. Um, so it's all incorporated into the monthly fee. I do have them sign a contract, um, not that I enforce it or anything, and I tell them I'm not gonna hire a lawyer or anything.

Like, if you quit, you quit. But I do tell them even in the contract that the only reason I'm asking them to sign that is because I schedule my family's vacation. And everything around their due dates. So, um, I think that's why most people want their ob who sees them during their whole pregnancy to be the one that delivers them.

So I just ask that there's kind of a mutual respect, you know, like if I know something's coming up or if I know I'm gonna be out of town the week that they're gonna deliver, I'll tell them upfront like, there's a chance I may not be, you know, the one delivering you. So, but I think, you know, everywhere is kind of unique about.

What you can do, what you can't do. I had gotten an ultrasound machine from a neighbor who was moving out of their office and he said he was opening another office, but it was gonna be a while. So he actually let me keep the ultrasound machine and it ended up being like a year and never charged me for it at all.

So I had like a free ultrasound machine, so I incorporated ultrasounds into it and then just reduced the price. So that was another benefit. And then the good thing about having ultrasound is everyone wants to see their baby and, and you don't have to charge them every time if you're not having to pay for it.

So, um, that was probably one of the bonus things for, for that. And I think anybody who wants to do OB and, uh, DP C having ultrasound skills is phenomenal. That is one thing. Like, and, and we saw it with covid, like husbands not being allowed in. So we were able to say like, Hey, anybody want can come to your ultrasound.

Um, you can take pictures. You can, there's a lot more leeway with rules than if they go to an imaging center, and that's awesome. And I definitely, my next question there is for those people who. Past residency, um, not necessarily able to go to a fellowship for obstetrics. Do you have any resources or classes, um, that you would recommend or even devices that you would recommend for people who are looking for ultrasound, for obstetrics in their own clinics?

Yes. Um, so aac oh, which I don't really know what it stands for, but it's a h e. But there's a program in Houston. I did their training. It was very good. Um, I do think if you're gonna do OB and you want to do first, second, and third trimester scans that it is important to have a better machine, then maybe a handheld machine.

While handheld machines are good for, you know, finding heart tones, making sure maybe it's positioned, um, if you're gonna charge them, then you should have the skills. To look at everything, um, you know, look at the ovaries, look at, uh, everything that a first, uh, trimester ultrasound has protocols for. Um, if anybody wants those protocols, I could easily, uh, give them to them as well.

But those are standard protocols for what's, what needs to be measured and, and everything in it. If you're not gonna do that, that's fine, but if, if you do, I think you need to do it right. And I do think that having a, a bigger machine with more capability for obs is better. Awesome. And in your area, um, just because the, the listeners like myself might not know the Corpus Christa area, do you guys even have a lot of options when it comes to cash pay imaging?

If somebody were to need, um, you know, a, a like a, you know, anti sono or something that was, Offered or that was necessary but not necessarily offered in your office? Uh, we do have some options for cash pay. Um, it is a little bit harder, and especially, so whenever you order imaging, like let's say you wanna do a bp, uh, which is the biophysical profile and you wanna wait, that's like two.

Uh, for the imaging center. So they're gonna charge them two prices where it's not that much more so if you could do it or also hours. So, um, like if somebody says they don't feel the baby moving and it's seven o'clock at night, there's no options except for the ER if you don't have an ultrasound machine.

Um, so in that regard, We are very close to Mexico, so I do get a lot of either undocumented or uninsured people who are scared to go to an ER because they're scared of, I don't know, being sent back or, or whatever. So, uh, they try to avoid it as much as possible. So, you know, having an ultrasound for those patients can be more reassuring, even, you know, given what you've shared.

In addition to ultrasound, um, can you touch on other pieces of equipment or materials that people should have available from a bare bone startup viewpoint if they are going to incorporate obstetrics into their D P C? Yeah, so you're gonna need a doppler. Um, they're gonna need speculums and lights for sure.

You're going to need either Nitrazine paper or. The more expensive Q-tip. Um, something to measure the fund high doesn't have to be. I think last, last year at the dpc, they had, um, somebody who was giving away those. Was it you or no, or was it DPC Alliance? I don't know. Db DPC Alliance. Yeah. Yeah. You were giving measures.

My office. I was like, this is great. Um, Always helpful to have a delivery kit in your office in case something goes wrong. So one of those little plastic things to clamp the cord. Uh, a bulb suction of. So, yeah, it's so funny, I'm laughing over here because, um, I'm an hour and a half from the hospital where I preferentially delivered up both times.

And, um, that was, that's like the stuff that I would carry in the car. So I'm laughing, I'm like, oh, I totally had my cord clamp in my wallet, so that's awesome. And, um, And I think that it's really great that you mentioned those things because when people are asking like, oh, what do you open your D p C office with?

It's not usually around what do you open if you're going to practice obstetrics? So I really appreciate you mentioning those things. Mm-hmm. Now, in terms of you opening, you had few weeks to open, you had found office space, but um, What was your opening like in terms of, you said you had zero patients, did you have a lot of OB people, a lot of OB patients joining on as your first patients, or did you have more family practice, non-pregnant patients?

Uh, join your practice first, I think we had more non OB patients, uh, joining us. And then, um, I printed some flyers that said, uh, are you pregnant without insurance? And. Lady with a pregnant belly on it. And um, and we had the reverse in Spanish and we started handing those out and then they just started coming.

Um, and then we kind of networked with, uh, there's a pregnancy center here and, um, an S Q H C that they don't really, uh, deliver their patients. So we kind of started networking with them and giving them information. And then the patients just started coming in. And to tell you the truth, even though like I always focus on, you know, Spanish speaking or undocumented, the number of patients that I have who are just the working middle class who don't have insurance and then all of a sudden get pregnant or, or even people on a health share who, uh, they didn't meet their time goal before they got pregnant.

Um, so they were kind of without insurance or. Uh, I've had people who are like, oh, I have insurance, and I thought I was covered, but for some reason it doesn't cover OB care. And I was like, what kind of insurance doesn't cover ob? Um, and sure enough it didn't cover anything. So, um, I get a lot of people who are like just middle class who don't have insurance.

They're like, we can't afford to work and have insurance and everything else. Definitely. And you mentioned how you charge a monthly fee for obs. How do you talk to them when they're onboarding at your practice, about how does it work between your services and the hospital services? So I do let them know that what they're charged in the hospital is not my fees, but there is a charge for the, the hospital part.

I went to the hospital and negotiated with them and it was like pulling teeth to get those prices. And that was prior to that, uh, bill that came out where they're supposed to have more transparent pricing. So, um, I don't know, maybe that will help people who are starting now, but, um, Happened to run into the, uh, the president of the hospital at, uh, in the doctor's lounge.

And he said, oh, I, I was like, oh, I haven't met you and No, I'm the president. I was like, oh, okay. And he was like, if you ever need anything, uh, just let me know. And I was like, turning to walk out the door and I was like, this is your chance. So I was like, yes. Um, I actually need some privacy scene for the.

And he was like, oh, okay, well I'll, I'll put you in con. So he put me in contact with someone, I think, because it was him saying it, all of them. And I got this pricing right away. So it was like perfect timing to be in the doctor's lounge. And, um, but I, I also put that in the contract. This is the price for a vaginal delivery based on a uncomplicated delivery.

This is a complicated vaginal delivery. And this is the pricing. This is a C-section. And these are all based on, you know, for a vaginal delivery, one night's day, uh, C-section, two nights day. Um, and that, you know, it is, it is an estimate. So it could be more than that, depending on, on what happens. Um, but, but I do give it to them.

And then they also gave me the pricing for if they pay, uh, like half of it. Or a quarter of it, then there's a certain percentage discount if they pay half of it upfront. If they pay all of it upfront, there's a like 75% discount. So just to let the patients know, some of them can't do that. But um, just knowing that it's, um, that they could be on either a payment plan or get a significant reduction if they paid more upfront.

And then I also let them know that, Everything in the hospital will be under my name, but it's not my bill because I've had some of them be like, will you bill me for this and this? And I'm like, I'm the ordering physician over there. Everything goes under my name, but I am not the one billing you. So, and what happens if there's any, um, pathology charges or NICU charges or anesthesiology charges?

So that is left to. Patient to negotiate with them. And I, I tell them, you know, um, things that are not covered and for our contract, it's their prenatal, postnatal care and their delivery with me. But as far as their hospital charges and that it is to be expected that some of them will show up, you know, six months, seven months after you deliver.

And. In your area, have you found organizations that will help? Because how you described, you're so close to the border with Mexico, have you found organizations that will help support, um, the needs of some of your patients if they find themselves with extra bills that they didn't expect going into labor?

Well, I have actually opened a nonprofit called my, um, specifically to help those patients in need for OB care, um, and to reduce the pricing because. So I feel like my pricing was great for the OB package. For some people it's just not affordable. Um, and I always wanted to have affordable and, and helpful.

So filtering it through a, uh, nonprofit opens the door for either grants or donations from other people to kind of help provide for, for those patients. So that is the goal, is to, you know, find a way to help kind of reduce their hospital costs, um, as. But yeah, we are in the process of working on that. If anybody who's interested in having direct primary care, uh, ob, uh, wants to come join me, uh, please call me.

I would love to hire another doctor to work with us. So, I just love this. I mean, you're sharing about how you were, you know, red in the face asking for an office space, and here you are talking to the president of the hospital and negotiating prices and you're gonna get partners left and right from, from mentioning that on the podcast.

I love it. Absolutely love it. So good. So given that you have a, a space that's close to the hospital, you're doing deliveries. Um, one thing I wanna ask is, do you do Vbacks at your hospital? Yes, we do. Mm. Awesome, because I know that that's not always an option in, um, in centers and around my area. Um, so definitely wanted to ask that, um, especially if future partners are listening and wanna do VVA as well.

And also when you mentioned that as a family medicine doctor who does, who actively does obstetrics, that you don't necessarily have a group to, to hang with the family medicine nor the, nor the just OB gy. Um, when you. Started your D P C and you were at your hospital. Have you, have you had any pushback from your experience now as a D P C doctor, um, delivering at the hospital where you have been for years?

Well, I think because I made the transition from academics to D P C and I was still in the same hospital, I think it was harder for me. That nobody realized there was a change. They all thought I was still with the residency program. I don't know. For me, I wanted to separate myself from them. Um, not because I had any problem with them, but I just wanted to be my own.

Um, so for me the problem was more like, how do I separate myself from them rather than dealing with the obs. I think the obs were used to me, but they all thought I was with the residents and. And same thing with the nursing staff or, or everybody was like, oh, well where are the residents? And I'm like, oh no, I have my own practice now.

It's just me. And they were all like, what? Like, uh, cause I had spent so many years training, um, other doctors that they were always with me or medical students were, it was always like two, three people in the room. So, um, for me it was kind of refreshing. See myself in the room and not have any other learners.

So, uh, I think I'll get back to the point. I do love teaching and I, I do love residents. That probably won't be long before I'm like, come on, come with me. Like let's learn something cool. I love doing ultrasound with them too, so, um, but yeah, I think, you know, depending on where you work, a lot of people have issues with other OBGYNs either call schedules or what they're able to do or not able to do.

We are lucky enough to have OB hospitalists at our hospital who are very supportive of us and back us up. Um, we'll attend your C-section to help assist you if you need, or we'll come into the room if you need help with like a vacuum or something like that, or just want a second opinion. You can run over there, there 24 hours.

So, um, they are all super awesome and I don't think that's the case everywhere else. Um, but we are very blessed to have them and, and our MFM have been great too. I mean, I feel like I could call them for anything. Um, Tend to get very complicated patients here. Um, just the number of things and their confidence in, in us.

They're like, oh my goodness, you can manage this. Like we did that one case together. And they're like, you got this. But just having their support is, is awesome. Um, so, and I know it's not like that everywhere, so I just have to say I'm probably super blessed, uh, here and. But yeah. So now in terms of being a family medicine with obstetrics on board, what have you found is your best option for malpractice in the state of Texas?

Um, there are quite a few options for malpractice in, in Texas. Um, I have to say, plan on paying a lot more for your malpractice than a typical D P C because you do have more risk and liability, so you're probably gonna pay double, maybe triple what somebody else might. Um, but I have to say this too, I am never worried about getting sued in D P C, whereas in academics it's super scary cause you don't know your patients and you feel like you can't communicate with them.

And I think that's what the majority of lawsuits, especially in OB, is like. Uh, nobody contacted the doctor or they, you know, weren't aware of this in this model. Like, we're aware of everything. We know you, we're the only ones who see you. And I think, um, that's why people come to you is cause they know you are the only one seeing them during the whole pregnancy, and you're gonna be the one that sees them postpartum.

So I think the risk of a lawsuit is a lot less, uh, in d p. Awesome. And when you talk about D P C very frequently we'll see, you know, D P C doctors taking a cap on how many patients they have in the practice. So how many people do you take at one point in your practice when it comes to OB versus family medicine, non-pregnant OB patients?

I haven't really put a cap on it. Um, I have taken breaks from OB because, Um, the call can be a lot. So sometimes the family strain, um, not being able to leave town. Um, some issues with, with call or having a backup. Um, so I would say there have been times where I said I'm not taking OB for a short period of time so we could go on vacation and be stress free.

Um, but, uh, I really haven't capped a regular amount of. Um, I ha honestly, I have not done any much marketing. I mean, I post on Facebook here and there, um, so I'm not actively out there, you know, trying to get 300 more patients or something like that. Um, or even the obs, I mean, we hand out the flyers to those two locations.

And other than that, I don't do any outreach or marketing or, um, newspapers or radio or anything like, so, So we kind of have a steady, steady flow, but it's not too much. It's incredible and it shows how needed your services are in your locale. So I think that's awesome. Um, what about your overhead? What's your overhead like in terms of, um, separate from malpractice?

What types of things do you have and your overhead because of practicing OB and family medicine? Um, so I did hire a, uh, sono. To help. Um, which is great. Um, and the good thing about it is they can be scanning and you can be watching, um, and then they're putting everything in. It's kind of like, um, oh, what do you call those people who write your notes for you?

Uh, ascribe. Ascribe, there you go. Um, kind of like that. So they're, you know, as you're seeing it and you're discussing it, they're putting everything there so it saves time. Um, and, and then also their expertise. They're just, The lady I hired is phenomenal. She's like, great with patient care. And she, um, and she'll be like, oh, here's their hair and here's their, you know, their fingers.

And she like points out everything to them, which like, as a physician, you're kind of like, okay, here's a heartbeat. Like you're key points. So if you forget sometimes that whole like, oh yeah, they're, um, new mom and they have a baby, and like, they're excited. So, so that's been great. But that is the, you know, like hiring somebody else and then, The ultrasound, I would say, and then probably, that's pretty much it.

And you really don't even have to offer those services. So not a lot different than a direct primary repair as far as overhead, maybe just, I mean, you definitely have to have an exam bed with, um, stir ups, uh, and those kinds of things. So this is a question. Is coming from, um, you, you mentioned how you were in the Dominican Republic in Haiti and other countries, um, and even in Iran.

Um, when I was in the dr, we had. Very creative strategies as to like how to do pelvic examinations because it was like anything went. I mean, gym floors, uh, park benches, people's bedrooms that we use, their beds. Um, Have you found any, uh, ways to MacGyver, you know, like massage tables to have stirrups added?

Because this is, this is actually coming off of a conversation that I had with Dr. Amber Becken Hower when we were in her, um, her brand new area where she has aesthetics chairs. And we were trying to think about like, how could we weld or do something to add stirrups to an aesthetics chair because it's sometimes cheaper than a medical.

Yes. Um, luckily I have not had to, because funny story, someone in the building was getting rid of a exam table and they were like, but you have to come and move it. And I was like, okay. Every, anybody who's tried to exam healed are super heavy, but my husband, um, Bill's houses and he's like very smart about those things.

And uh, so I told her, okay. And she's like, she sold it to me for very cheap because she was like, Somebody else wanted it, but this thing is so heavy and I can't figure out a way to move it or whatever. Well, I went in with my husband, you know, those dollies that have like four wheels. He like just lifted the bed, slid that thing under, and we were gone in like two minutes and she was like, what did you guys do and how did you get it out of there?

And she, so I think I was blessed to have those beds at a very cheap price from somebody. So I haven't had to, but I'm sure there are ways and I've used like, yes and do, and I, when I said that you need them for overhead, you're, you're right. You really don't, um, mostly here in America, you just feel like you need something, but you don't.

Um, but yes, in like Dominican Republic or whatever, we would turn over, uh, like Tupperware tubs and they would sit their bottom on it so that it would just lift up the pelvis kind of area. But yeah, there's all kinds of things, but I haven't had to do that yet with, uh, kinda one of those aesthetic type bed that's a challenge to the listeners.

Uh, so come find us at the D P C summit in June and if somebody has a solution to that, um, ironically I'm interviewing Nick Thompson, uh, in a couple of days, so I will ask him. Um, but. Let us know, because that definitely could be information that somebody could use, whether they're practicing in the states or abroad.

So we can take it to Shark Tank. Love it. Love it. Um, you mentioned how you were, um, providing leaps and copos for a clinic that you were working at, and you continue to do that in your own practice. So in terms of having like a colposcope and procedure tools for leaps, did you invest in those or how do you, uh, work those procedures into your.

So some of them, um, the clinic that I worked at before, they offered to me because they were updating their, um, supplies and, and equipment. So, uh, older versions of them. And I find I would not buy a new one if you're not gonna do it all the time because they're very expensive and there's so many people who are updating or, or businesses that would love to give you their old one.

I think even with the residency program, we. Three or four of them sitting there, um, that just were not used that often. So, um, not that hard to get the equipment. Um, so I wouldn't invest. Great. And in terms of your price point, how do you, uh, price out leaps or copos for patients, whether they're in your practice or whether they're non-members?

Well, I include it in the, the cost of the, the membership. Pretty much most of the procedures I do are all included in the membership other than, well, even deliveries are for the OB membership, but. Given that you are so close to the border with Mexico, when you have people coming to your practice and they're, you know, not, not in a place where they're afraid to talk to you openly, do you see, um, more serious pathologies, not only in obstetrics, like you mentioned, but also with, with, um, non obstetric related diseases and how do you handle the severity of disease when you, um, if, if you see that, uh, coming through your.

Unfortunately, Corpus Christi has a very, um, I would say poor health score overall for a lot of the population here. Um, as far as people not seeing doctors on a regular basis or having, uh, issues with, uh, obesity here is very big, or diabetes, um, people coming across the border tend to have similar things, but I would say some things.

And I, I really haven't had to deal with those as much here, but, you know, people having rhabdo or, or things like that because they were several days without food or water en route or when I was with the residency program cuz I did their ob. You know, having minors who were raped along the way or. Uh, those kinds of issues getting pregnant along the way or, you know, an issue of being molested and, you know, some kind of sexual assault and that's the reason why they're leaving their home and, and trying to come here.

Um, so a lot of times because they are, um, hooked up with like an immigration center or something, they have to go through a program that has funding or sees. Uh, takes some kind of like government insurance or whatever, but um, a lot of times they will, uh, try to get them with family. And then the issue is, you know, the family doesn't have insurance for them.

So, you know, once we saw them and then they flew off to be with family, it was kind of like this, you never know what the ending was. But, um, I always thought about it like, well, you know, maybe the family. Didn't want that financial cost or didn't really, weren't that close to them. And then, then they're in the middle of somewhere else, even though they had family, they're in a, a bad financial situation, pregnant.

And then the other thing was sometimes they would be asking for you to sign off for them to fly. And then I'm like, but they need to see mfm and there's no guarantee, there's no appointment set up for mfm. I don't think they're gonna get in. So, But as far as the pathology, I think it's pretty similar. I can't say that it's, uh, that different, but that may just be, uh, cause I've only seen so many patients and.

Okay. Awesome. So, Dr. Kati, I, we have mentioned that you're gonna be, uh, a speaker at this. Here's DP C Summit. I wanna, I wanna close with who should think about, like, if, if people are attending the DP C Summit or if they're on the fence about it, who would be the perfect audience member for your talk at the DP C Summit this year?

So anybody who's interested in women's health or. Or even ob even though I won't be talking about it, you're always welcome to talk to me before or after about it. Um, I do have a passion for both of those topics. Um, so I will be talking about, um, different pathology of the cervix, you know, how to manipulate to get.

Uh, a good path or how to, you know, determine whether somebody needs a copo or, or those kinds of things. So, um, yeah, I guess anybody who, uh, has doubts about tho doing those, uh, exams or how to treat them or, um, just wants a few tips or secrets about how to get the, the best, uh, biopsy. Um, and hopefully I'll have some things set up there to kind of, um, simulation, like a lab.

Yeah. Yeah. So something to simulate, um, collecting biopsies. And just one more thing on that note, um, just because especially with the OBS that I've worked with over the years, um, people have lots of different apps that they recommend. Do you have any particular apps that you love? Um, you know, whether it be the, like a S C C P app, um, that's like 10 bucks and totally worth it, in my opinion.

Yeah. Or other apps that you love to use every day. So I would definitely second that A S C C P app. Um, that thing is like gold. I use it all the time. Uh, any p So, uh, for those of you that haven't used it, it's a nice way to, uh, recheck the screening guidelines, um, to make sure you up to date on those as well as you can put in the PAP result findings and either the, um, al findings or.

Uh, to determine there's like algorithms to determine what's the next step. So it's extremely helpful, good reminders, especially for family practice, um, because we do so many things. So just knowing it's there, I'm always like, okay, well I can just double check with the app always. But it's a great resource.

And, um, A S C C P also offers a CME course where they do purple training. Um, and I went to that several years ago and it's phenomenal. It's, uh, a great opportunity if you get the chance, um, to go and try that out. So. And do you think someone who is, um, who might be, you know, a few years out of residency, do you think that Copo training is sufficient to start practicing copo in their offices?

Yes, definitely. I. Honestly, there's lots of nurse practitioners out there and all kinds of other people doing copos. So, uh, if you've done a residency program, you could go to the training and you can do it. Um, and if you need a little support, just call me. Love it. Thank you so much Dr. Kati, for joining us today, and I can't wait to see you in person at the DP C Summit.

This. Yay. I'm so excited. Thank you for having me

next week look forward to hearing from Dr. Nick Thompson and Dr. Brandon Allman of Antioch Med in Wichita, Kansas. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about dpc. Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these DPC stories.

Lastly, be sure to follow us on. If you're wanting to continue learning more about DPC in the meantime, check out DPC Until next week, this is Marielle conception.

*Transcript generated by AI so please forgive errors.

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