Direct Primary Care Doctor
Dr. Medina Galvan, MD and her team provide patients with the best service in the North Houston area.
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Dr. Medina Galvan, M.D., is a board-certified Family Physician. Dr. Medina Galvan is currently an active member of the Texas Medical Association & Harris County Medical Society. She served as president of the East Branch of the Harris Medical Society in 2018.
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Dr. Medina Galvan believes that everyone should have access to affordable, transparent high-quality medical care. She is well-equipped to treat patients with her experience and the empathy they deserve.
In today's episode, Dr. Medina Galvan talks about her experiences opening and running her direct primary care clinic, offering various services like weight management and aesthetics, and investing in equipment and training. She also shares how she evaluates the financial aspects of adding services to her clinic and the importance of knowing her worth as a business owner. She also talks about her initial difficulties in getting patients to convert to DPC and her decision to add one-off services to her practice.
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Transcript*
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 Fifer 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 allows me to embrace my freedom as a physician and entrepreneur. I am Dr. Medina, owner and founder of Luminous Health and Wellness, and this is my D P C story.
Dr. Deanna Medina. Galvan was born in New Jersey and grew up in New Mexico. She's a graduate of New Mexico State University and obtained her medical degree from Unni Iro Americana in Santo Domingo, Dominican Republic in 2008. Her residency was completed in 2013 at Houston Methodist in Houston, Texas, which is affiliated with Cornell University.
Dr. Medina Galvan has over 10 years. Experience as a family physician with special interest in obesity medicine and hormone replacement therapy. She's currently an active member of the Texas Medical Association and Harris County Medical Society. She served as president of the East branch of the Harris Medical Society in 2018.
Dr. Medina Galvan believes that everyone should have access to affordable, transparent, high quality medical care. She is well equipped to treat patients with her experience and the empathy they deserve.
Welcome to the podcast Dr. Ma. Thank you so much, Dr. Ep. It's such an honor to be here. It's my pleasure. I know we've been talking about getting you on the air for months, and so I'm so excited that we're finally here at this moment, so you get the whole platform to share your story and what a story it is.
I wanted to start with the name of your clinic because it has such a wonderful, um, it has such a wonderful story behind it. And for those of you who have not heard the story before, one, Dr. Medina is going to going to share it, but also, um, she has it greatly featured on her website, so you can also see who she will be talking about.
If you visit her website. So can you start us off with sharing the beautiful story that, that goes with your logo and the name of your clinic? Thank you so much for the opportunity, Dr. Cep. So I decided to name it Luminus just because when I would have certain difficult, uh, patient encounters in the prior practice I was working at, my patients would tell me, I had one patient tell me that I was like a breath of fresh air.
I had another one tell me that I was like a beacon of light and darkness. And so that really stuck with me and I knew that one day I would open my own clinic and I wanted to name it something of that sort. So I liked the name Luminous and I added health and wellness. Uh, the story behind my logo is, is pretty interesting.
So when I was a resident, um, I almost quit. I was second year. I almost quit residency cuz I just, I couldn't take it anymore. At that time, my Aunt Edra, who was like a second mother to me, um, was in the hospital and she was very sick. And just to backtrack a little, when I was a child, she took care of myself and all.
My other first cousins we're a total of about 40 because my father came from a large family, total of 14 siblings. So my family, I took care of a lot of us, and I was one of them. And for those of you that know me, know that I'm, I'm a piece of work. And as a child, it wasn't any different. And so, um, things would break and they would ask who did it, and they would always say, Deanna did it.
And my aunt would come to me and she was like a whole four feet, 10. She maybe weighed 90, a hundred pounds, maximum dripping wet. And she would say, did you break that? And I would look at her in the eye and she would say, I would say, I didn't break that. And she would tell me, I see a little horsey on your eyes.
So I would run to the bathroom to look at the horsey. And the horsey was never there, right? And I would give myself away unknowingly as a child because I would go run and look for the horse. So back when I was a resident, she was, um, admitted. She got very sick and I see her and it ttia, I'm, I'm having a really hard time.
I think I'm just gonna quit. And she gets very close to my face, maybe an inch from my face, and she says, I see a little horse. And so of course I immediately started sobbing. I, I don't know what to do. And basically her words were, Youth swam in deep waters to come drown at the shore. Like, you can do this.
We, we don't give up miha. And so when she told me that, it just, it was exactly what I needed to hear to keep on going. And so I didn't give up. And she loves butterflies. She loved them so much that my logo is actually butterfly shape, but it's actually two faces looking at each other. And it's her looking at myself.
And the colors that I chose were colors of the ocean because whenever I've made, um, big decisions in my life, I would go to the ocean to just meditate. And so that's, that's how my logo came about and that's why I named Luminous, luminous Health. And.
What a gift. She has continued to leave with you and your patients and your family going forward.
And the, you know, when we talk about family, I want to just point out that, um, Dena has just given birth and welcomed another baby girl to the family. So she's such a champ. I, I could not be in your shoes doing what you're doing right now because I would be passed outta sleep with a newborn. So it is, it is so awesome that she made such an impact on your life and that you continue to be a physician and, you know, rep and, uh, celebrate her presence and her gift to you every day with your.
Thank you. The other thing is, you know, I was so used to being in a traditional fee-for-service practice that at one point I was scared to leave. I was like, how, how am I gonna figure everything out? And so the thing is, butterflies, they start off as caterpillars and eventually end up as beautiful butterflies.
And then they, you know, they start, um, flying around. And so, so that, it was, it was like such a symbolic meaning behind using the butterfly as my logo. Also, because I've evolved so much as a person, as a physician, as a mother, as a wife, just being a business owner.
So when you mentioned fee for service and this evolution that you've gone through, or this, excuse me, and this metamorphosis that you've gone through personally, I wanna go back to your time in fee for service, because if I'm not mistaken, you were in fee for service for five years before you opened your D P C.
Is that. So I did fee for service for five years, and then I did three years of urgent care. And during that time that I was doing urgent care, I opened my D P C practice and then eventually I stopped doing urgent care and just dedicating myself to, to my practice.
So let me ask you there, when you went from five years of fee for service into urgent care, what was the reason you chose urgent care versus doing something else or even leaving medicine
at that point?
That's an interesting question. I thought that it was that I didn't like primary care and maybe that I went into the wrong residency, and so I had a lot of doubt about my future and what I was doing. And so I had a very good friend of mine, actually my residency best friend, who was working, doing urgent care, and she was like, I love this.
You're done with the shifts and you don't have to worry about anything. You don't take charts home. And that was very appealing to me because one of the things that I loathe was taking work home. And even though I was physically present in my home, I was not, it was like I was absent. And so I said, okay, let's do urgent care.
And urgent care was okay, but when you work for a corporate, a big corporation, there's a lot of things out of your control. And so then that got old really quick, and that's why I was like, okay, I, I can't do this anymore.
And when you shared about opening your D P C while you were still in urgent care, how did that
transpire?
You know, everyone's like, okay, good luck. I've never heard of this model. Like, yay, good for you. And I was like, okay, good for me. And I just kept working on it. And little by little I started getting, um, I guess getting more vision and, and getting more support, not only from my family, from my husband, but also from other D P C mentors and friends that have already been there, done that type of thing.
And in terms of when, along that three-year journey in urgent care, um, did, when you started your D B C, at what point during that time, or had it been even before you started urgent care, did you learn about d p.
So I learned about D P C actually by going on the Facebook grant. But the story behind that is I was very pregnant with my first child and I was getting dizzy.
And so I didn't want the doctor myself, and I didn't wanna see the physician owner of that practice or, you know, the PA in there. And they're very capable. But I wanted to keep my business separate. So my deductible at that time was $4,000 and I belonged to a, I enrolled myself, um, as a patient and one of, um, A very known, well-known clinic.
It's one of the biggest ACOs in the Houston area. And of course when I go there, I don't tell 'em that I'm a physician. I just kind of lay low and they do this work upon me. The physician was there less than 10 minutes. Next thing you know, I get a huge bill in terms of labs. And so when I call them and I say, you know, these labs are not that expensive.
Why am I being charged over a thousand dollars for these labs? That's when I learned, cuz I never had experience as a patient, you know? Um, because I didn't, I just never went to a doctor in the past. And, um, they were like, well that's the rate you get charged because, because of the insurance that you have, right?
And that's the contract between LabCorp and your insurance. And I said, well, is there any way I can pay cash? Cuz I know the cash prices are much cheaper. And that wasn't an option. So I was so aggravated with the whole thing. I go off on Facebook, And I usually tell people, my Facebook, I express a lot of things, a lot of my feelings.
So you can either block me or keep scrolling and I don't even get hurt. And somebody told me about D P C, and so then I said, oh, that's interesting. And then I started reading, and the more I read, the more I fell in love with the idea. I started off by reading Dr. F Rego's book, and then I read Julie Gun, Dr. Gunther's book, and then Dr. Thomas's book. But I became a member of the D P C Private physician group. And that was just lurking. And what I did is, at that time when I joined, which was, I don't know, maybe 2016 or even earlier, what I did was I went through every single post that was posted by physicians.
I took a notebook and I just started writing questions and answers of things that were relevant to me. And then I was just up to date with everything. So I had it kind of like a plan of like what I should be doing prior to opening my my own practice.
That's awesome. And when you, um, when you had that notebook going, what were some of the major categories that you classified, um, that you organized your notes under?
I didn't have any organization. I just kind of went, I'm being honest, it just didn't, and I was just going through, um, each post and just writing down what, you know, what needs to be done. And then I just kind of, after that went through the notebook, highlighted things that I should get done first, and then I just took a step by step.
I made a lot of errors. Um, everyone in the post, in the D p C group said, keep it small. Keep it small. But in my brain it was like, go big or go home. And I did a total opposite. So I got a very big loan, huge loan. Uh, Worth more than my house. It was more, it was like a half a million dollar loan. And I did this build out on this tiny space and it's beautiful and everything, but I wish I would have listened a little more and started off small.
Um, but I mean, I've already cried over that, that's just water under the bridge and, and I've learned from it and, and it's okay. So ideally I would have liked to have started small, maybe rent a, a small space leasing or subleasing from somebody else that's establishing a community, but I didn't go that route.
And in terms of being in the Houston area, did you also get mentorship from other D P C doctors in the Houston area in addition to the DPC presence
on Facebook? Initially, no, because I didn't know that many, uh, physicians n doing D P C in the Houston area. But then the more involved you become in the group, the more you know famili, you familiarize yourself with other names in the area.
And so I became friends with some of the local D P C doctors that are not very close to where I'm at cuz Houston is pretty big. And then we, we, we curbside each other. I mean, we're friends and so then, uh, we just bounce ideas off of each other.
That's awesome. And going through the questions that you, or going through the posts that you saw on D B C, on the private D BBC Docs group and then meeting and talking with people locally, what were the questions that were unique to Houston and Texas in general that you needed more information on, that you got answers from?
Um, that you got answers that you got, that you got answers to because you were talking to other Texan physicians?
One of the major things is pricing and how you should structure your clinic. And so what I've learned is that not every D p C practice is the same and you don't have to do what traditionally has been done in D P C.
And what I mean by that, I, I am not available 24 7. I used to be available 24 7 until, um, October, 2021. And that changed, um, I had to do increase in my pricing. So basically what I'm trying to say is the pricing depends on geographical location, right? So I will not be able to survive on a 50 $70 a month membership.
Uh, my prices are a li a little more comparable to the other doctors in the area, and the most I charge for membership is 1 35 a month. Gotcha.
And when you mentioned the loan that you took out, How did you get that loan? Did you shop for different types of loans? What was that process like? Especially for, um, for, I, I asked this, especially for those people who might be interested in looking at loans, um, to open their D
P C.
So what I did is I went to a local bank and they have a lot of banks usually have physician loan programs. And so what I had to do is show them how much revenue I made for that first office. And so I had all those financials and so they basically did a credit check and they did a whole number of other things.
And basically I got the loan. Initially I didn't think I was gonna use that much. I thought I was gonna use maybe a third, but then build that is really expensive. And so I even had a downgrade on a lot of things. Um, and it still was. The way it turned out. But I mean, I'm happy at the end of the day. I'm happy.
It's my space. I don't have to worry about moving out, relocating or anything like that. And, and I think for me, I told my husband, well, everyone thinks I'm crazy. I'm doing D P C. It's either gonna work or it's gonna work. We're gonna make it work. And so that's been my attitude since the beginning.
I love that. And the lack of scarcity mindset when you talk is, is really empowering. And it definitely, um, I feel when somebody is thinking more in a, um, abundance mindset versus a scarcity mindset, the mind tends to think in, okay, I'm working with a level of abundance versus I'm trying to fight my way out of a scarce environment.
So I think that's great. And when you have, you know, been in this place of it's gonna work or it's gonna work, um, early on versus now, what have some of your, um, Pivots been to continue on that trajectory of I'm gonna make it work or I'm gonna make it work.
Wow, that's a loaded question. But one of the things was boundaries, right? As a, a small business owner, especially when you're starting, it's hard to say no to some, some things, but what I've learned in almost four years, so March 18th will be four years, is that not all money is good money. And you have to know what to say, uh, to the prospective patient, this is not gonna work. I don't think I'm a good fit for you.
And do not be afraid to say that. And. The other thing that I did was, for instance, I would reply right away to messages because I wanna show them that I'm available to you. But at that's not realistic, because what was happening is as I started growing and I wasn't responding within the next five minutes and I would take an hour, patients would get so upset like, oh, what took you so long?
And I'm like, well, I got more patience. Can I relax? So, I had to pivot a few things. The other thing I had to do is, um, I had to implement an enrollment fee, cuz initially I didn't have that and my membership was just $99 a month to month. So what I found myself doing was a lot, a lot of work for very little pay.
I, the patients would get their records transferred to my office and sometimes these records were very extensive and I would just sit there and read them and then make summaries and put in the E M R and the patient would come in and get their, you know, molds removed. They would get procedures done cuz it's included as part of the membership.
They would get labs almost at cost. And then after a month right before that next payment hits, oh by the way, thank you so much. I'm gonna cancel. So I had to learn how to pivot and how to handle these situations. But most importantly, not take it personal because I gave every single patient that has walked through my door my absolute best.
So when you mentioned services like the, these patients would come in and get services. How did you determine that they needed those services before their, their visit, um, and before they canceled? Were, was that part of the intake form or did you, um, do services like procedures, like mole removals, like you mentioned?
Um, Because that came up during the first visit. How did, how did that
work? So, initially, like in the, I mean, I would have so much time. So sometimes my first patient visit would take anywhere from an hour to two hours. They're like, oh, by the way, I have this mole here. Can you remove that? Sure, I can remove it.
Remove it. But what I learned to do is just don't do any procedures at first visit. So again, these are just, you know, growing pains that you have to, you know, uh, be presented with so that you can learn how to modify your business. Right. And what I mean about other procedures, I tried so many things to get people in through the door.
The one thing I don't recommend is don't spend $40,000 in marketing, which I did the first year. And at one person walked in through the door and I used a very reputable company. Not one person walked in through the door. Okay. So the other thing is, uh, after the first visit, I would kind of lay, um, Outline of the subsequent visits.
Okay. So I can't address everything in one visit, especially if the patient hasn't been to a physician in 10 plus years. Like, I can't do a whole tuneup a whole, a whole tuneup in, in, in an hour, even two, because there's so much going on. So I would have to break down those, uh, visits. Um, that's one thing.
The other thing I, I, I started doing initially, which I no longer do, is because labs were so affordable, I wanted to get people in, Hey, your labs are so cheap. Come on in. You know, do you know your numbers? That's how I would market it, and people would come in and get their labs done, and if everything was normal, It was great, but then there were a few times labs were very abnormal and the patient didn't want to follow up because they didn't wanna join.
So that lefts me in a very particular, um, position, right? Because I have a duty to treat if I see something abnormal, especially if I ordered the labs. But, so like I said, you just learn as you go. Um, other services that I offer in my clinic include I do, um, f a class two and class three physicals. I also do, uh, hormone replacement therapy.
I do aesthetics and weight loss as well. So I wanna, I wanna take a step back because, uh, you mentioned how you marketed specifically about labs and come get your labs done. Do you know what your numbers are when you, uh, talked about your opening budget? Did you spend some of that opening budget on marketing and what specific marketing, and if so, what specific marketing.
Strategies did you employ?
So the first year of, as I told you before, I spent about $40,000 in marketing and not one person walked in through my door. And basically this company not only did my website, but also would write blogs for me and would also manage social media, they would manage, um, Twitter.
Facebook, not Instagram and LinkedIn. The thing that I found was that it was so generic that I don't think it got any traction. So that was the big thing. The other thing was these blog that they would write, I would reread them and some of them wouldn't even make sense. So it was like if they had, I don't know, a bot writing these blogs, not an actual person.
And so then I just became very unhappy and I said, I can't go on with this. They also were in charge of my website, so if I needed any type of modification to my website, I would have to go through them. And that to me was just, I was like, this is unacceptable. And so that's when I decided to, you know, cut ties with them.
What I have found that works really well, and I think other physicians have said the same thing as word of. And I tell my patients, if you're that happy with the level of service that I've provided you, please leave me a Google review. Please share it on your local mom Facebook group. Share it on your neighborhood.
Uh, pages, uh, also is social media, just getting in front of the camera, which I was definitely afraid of. And the way I, I decided to finally do this was because my sister at that time, who, who's now in med school, she's at Texas Tech would always record. And when we'd come home, she would just watch these videos and just laugh.
And I'm like, what's so funny? And she's like, you're funny, dude. You're funny. You should go on the camera. And I'm like, no, I'm not gonna do it. And because of my own it as a, as a woman, I didn't wanna go on the camera. And then one day I said, you know what? I'll give it a shot. So I started doing reels on social media, uh, specifically on, on Instagram.
And then I was getting engagement from people that I never knew and I didn't realize how many people I was reaching. And so, so yeah, that helped me overcome that. But that has been the best thing because I did have a non-compete with my first job. And even though it's in the Houston area, 10 miles is a pretty big radius.
Right. Especially when there's so much traffic. And I had patients that found me on TikTok or even found me on Instagram doing a dance or doing something that were my former patients at my own practice. So that has worked for me the best.
I am glad you mentioned the dancing, cuz if you weren't, I was going to definitely mention that.
You should definitely, definitely check out Deanna's uh, Deanna's, uh, uh, reels because, um, you, you find yourself dancing with her, so it's, they're pretty awesome. You mentioned the non-compete and so I want, I wanna ask there, was there anything else in your contract that was despicable or, you know, regrettable that, um, you, you know, were involved in at the time, at that job that you were grateful to get out of once you left?
Oh yes. So when I was at that job, my office was towards the front, and so I would see, and I would hear the interaction that the front desk would have with the patient. And so it quickly became apparent to me that if you have a very bad front desk person that can really ruin your, your clinic, your business.
And so the other thing is that my boss was an excellent boss. His, his office was all the way at the back, and so he was completely unaware of what was going on. But I would hear every conversation. So I made sure that in my office, that my, in my clinic, my office is towards the front, it's right next to the lobby.
So I hear everything and I'm able to see things through, uh, cameras. Yeah, that, that, that's, that's a, that's a good point that I, that I learned. What else did I learn? Oh, let me give you another example. Sometimes my clinic would start at eight in the morning, but then the manager would show up a little late and because of that, then the front desk would show up a little late because it was a friendly environment.
But the thing is just showing up those 10 minutes late is gonna throw off my whole schedule because then by the time they triage the patients, they get their insurance information and all that stuff. So I had to have a talk with my boss at that time and say, Hey, if the manager is leading by example and not being here on time, and I'm starting off late, that's why everything is so like relaxed.
So that didn't go too well with the staff. I mean, they were wonderful staff, but, you know, we had to get strict in that, that point. But I learned a couple things here and there, um, that were very worthwhile to, to incorporating my own practice.
So I, I am just shaking my head over here because I, how many, I think of how many administrators did I ex try to explain that to where the first visit is at eight, but they're not even roomed until eight 15.
And maybe by then their vitals are done. So how am I supposed to see a patient at eight? Exactly. I totally, I totally hear you and I feel you, and I know that there are multiple people listening to you share what you did, and they're probably shaking their heads too. So, um, crazy, crazy times that we have lived in, in fee for service and patients and doctors continue to live in, in, in that world.
So I'm glad that you're highlighting, you know, the, the disconnect between. Patient care and those, those types of clinics. So I wanna ask about, uh, when, now you mentioned that you offer multiple services in addition to primary care. So when, uh, when you mentioned the services, like, um, the, um, like the f a, a training, or excuse me, the f a, a, physicals and weight management and aesthetics, did you s, did you buy equipment, uh, as part of your opening budget for those different services? Or did you add on equipment as you added on services?
So it was the ladder I added on equipment as I expanded my services. And for the f a a, basically there could only be a certain number of AEs. That's what they call the medical examiners per geographical location. And so you have to apply for it. Then you have to take like some pre-test, pre-courses and then you have to attend the actual training, which is a week long in Oklahoma City.
And then you take a test and then after that then you're certified. So initially I can't do class ones, I can only do class two and class three. But the goal is eventually to be certified to do all classes for the, uh, aesthetics. I spent a lot of money on training, so it wasn't like I spent, you know, one course and said, okay, let's go do Botox cuz these classes are about $3,500.
Well, back then that's what it was. Um, but no, I've spent. Close to about, I think it's like the last time I tried to add things up, it was about 65 to 70,000 in training for aesthetics. And I think it's worth it because I wanna be able to provide these services and also say that I trained with, you know, key opinion LE leaders and I try to keep always up with that even though I don't do so much aesthetics, but I do do some.
I appreciate your transparency when it comes to, um, the investments that you've made. I wanna ask there, in terms of investments, when you are deciding to add another service or, um, go to a training to provide another service or by equipment to provide a service in your clinic, how do you, um, how do you evaluate financially?
Like which service are you going to provide next, and how do you then budget for that service?
I wish I could tell you I had this eloquent, very detailed, pragmatic thing. I just go with my gut feeling on things and, and a lot of people don't operate like that, right? But for instance, I knew I wanted to do weight management and I could have gotten myself a scale that cost me $500, but I had to go with the one that cost me.
I think it was 12,000 at that time. I haven't made my money back. Cuz for my members, it's free to get on the InBody five 70. But for people that are just, um, especially the people in the fitness industry want to come in and do their body composition, I charge $25. Have I made my $12,000 back? Absolutely not.
But that is a tool that I need so that I can provide, you know, weight management services to my patients. So, um, basically you invest in things that you feel like you can. Give good value and justify, you know, the, the price that you're charging. It's not all about, I'll be the cheapest, I'll be the best doctor, because some people are hesitant like, Hmm, you're doctoring, you're that cheap for, you know, primary care.
So there's a lot of, you know, controversy on like what you should charge, but I think you should also know your worth and the amount of investment that you are putting into your, uh, business to offer your patients.
And when it comes to offering patient care through memberships versus one-off services, what's your opinion on, um, on how to balance the two?
So initially I was doing D P C and I couldn't get people to convert to do doing D P C. So I was doing a lot of one-time visits and people would pay $150 like nothing. But then my D P C membership just wasn't growing. And I think a big piece of advice that I received from Dr. PC Rabel, when I called her, she said, you're shooting yourself on the foot.
You need to stop doing this one time visits, because then no one's ever gonna see the value in the membership. So once I, once I stopped, Doing those one time visits. And I think at that time I only had like, maybe 30 patients is when I started to definitely grow. Because if you like the way I treated you, if you like that relationship, if you like that rapport reestablished, um, then you would consider doing the, the membership.
And some people don't, don't wanna justify, well why should I keep, you know, paying for this membership if I'm only gonna see you once every two or three months? And I tell them, because when you need me, I am there and I'm gonna give you very, very good care. And the care that you receive with me is very proactive and it's not reactive.
And so then I tell people, you know what? You will put priority on things that you feel like are important. And to some people it's their nails, it's jewelry, it's their vehicle, it's shoes. Right? And. And, and if you see like your health is a priority, then you'll invest in it.
So true, and I'm sure you feel this with your patients who have remained members of your practice, is that the appreciation of your services and your value proposition in you as a doctor is very different.
Like the way that they talk about you in, in word of mouth, uh, you know, in when they share about your clinic and that word of mouth marketing that you talked about, it's very different than somebody who might talk about your services as a, as a one-off primary care visit and. Is talking about like how cheap things are.
So, um, that, that's a, it's a good point to make. What about your services that you offer as one-off services for non-primary care type services?
So that would be the aesthetics and that would be basically just fillers and Botox and, um, facials and microneedling and, uh, then the hormone replacement therapy, which is separate, uh, into the aesthetics.
I also do P threads and my goal is to eventually become d O T certified and certified to also do like, uh, fireman physicals and maybe, um, aircraft physicals. What is that called? Hold on. It's called, uh, what is that thing called? Ugh, forget. Didn't even put that in there. There's another type physical that pays really, really well.
Just so you know, Marielle, um, that the f a told me I should consider. So when
you talk about these other services, do you see patients returning for, like, do you see patients ending up. Being repeat customers because they're going in for a one-off service. It's not primary care, but it's something that like hormones or aesthetics, that it's, it's, these are procedures and services that don't re, that don't typically end in one visit.
And then you're, you're, you know, you're good for the future.
I've had some patients, for instance, when they're for hormone replacement therapy and I see that their blood pressure's at high, really high. I go, well, I can't, I can't give you any more hormones because it's gonna go, I can't prescribe you any hormones cause it's gonna make your blood pressure even higher.
Well, my doctor, I can't see my doctor for the next month or two months. I was like, well, when you get your doctor in one or two months to give you a visit, then you get that controlled. Then come back to me. And sometimes people are like, you know what? I don't want the hassle. Can I just join until they have joined?
Or even patients that are getting their, you know, Botox. Something as simple as, oh, I have acne and I usually get prescribed X, Y, Z. Can you do that for me? And I go, I could if I were your primary care doctor, but I'm not. And to then they join. So that's been really nice. And what's been fantastic is that, especially with my D P C patients, they know me so well that they trust me.
And if they, sometimes they tell me, what do you think of. Me doing X, Y, Z I'm like, well, that would sound great, but first we gotta get your A1C under control. Right. So then there's, there's a lot of cross crossing over, I guess you could say, between patients. Um, for the, for the patients that are, they're not considered my patients, but they're, um, f a physicals, I let them know that this is not a patient doctor relationship, then I'm just doing a regulatory physical exam to make sure they're safe to fly in aircraft.
Awesome. And can you speak to like, sort of like how we were talking about before we started recording, how it's nice to have one-off services so you're not having to do chronic care, but can you speak to that those, even though you're not doing chronic care management for patients who are getting aesthetic procedures or hormone replacement, um, that you are having them still come back for repeat services because you're doing services that, um, are not set it and forget it type of
procedures.
So that usually applies to the, uh, aesthetic procedures. Um, I, you know, I tell my patients the ones that wanna come in, let's say for lip filler, they're like, oh, I wanna look like this. And I'm like, well, your lips are really thin, it's gonna take a while. So we have to first build on that. So we first do maybe half a syringe or even a syringe, and then a month later have 'em come back and they're satisfied with the results.
And I tell them, I am not gonna put, you are my canvas, and so I'm not gonna have you looking like a duck with those duck lips. And people are gonna say, who did that? And they're, you're gonna say, it's Dr. Medina. I don't think so. So let's take things slowly. I need you to trust me, and then we'll take a step by step.
And a lot of the times, more than 90% of the times they come back, they come back because they, they like that service. And they're like, well, let's do something else. And I'm like, okay, well then let's do it. And so, yeah. So my goal eventually is to bring in a laser too, so that I can have the complete, um, aesthetic.
Treatment that I can offer them different services.
Awesome. And another unique thing about your practice is that you offer exclusively virtual only D P C memberships. So can you tell us about how you created that offering at your practice and how has that been working for you? So it's not something that I initially started with.
Again, it was because of social media. I had people from different states reaching out to me and just asking me questions. And a lot of times it's through dms and I tell 'em, I don't give medical advice through dms, but they were just asking you if theres something that you treat. And I'm like, yes. Oh, I've been following you for a long time and I feel like I know you.
And I'm like, okay, great. Thank you. Uh, can you be my doctor? And I just have to tell 'em, unfortunately I'm not licensed in your state, but I'm definitely licensed in Texas. And I kept seeing more requests for that and I said, okay, let's give it a try. And so basically it just started, uh, within the last couple months of 2022.
And so it's been going great and, and I love it. And I tell them that there's limitations to virtual visits and that there will be a time when I'm gonna have to go into a, um, facility, whether it's an urgent care or an er, because it's not something that I can take care of virtually. And they understand that.
And then that's it. We proceed. I do chronic, um, Medical condition management. I can still do preventative services. I can still do, uh, labs. So all that is it's great.
And nanny, earlier you mentioned how you learned, uh, a very important thing from your previous job in terms of being close to the front versus being farther from the front, um, where patients come in.
You have Jacqueline and Rosario, uh, working with you on your team. How did you come to, um, how did they come to join the practice and how do you guys function as a team, um, because of your experience at your former office and urgent care and other places you've worked?
So I think having a good team will make you very successful.
And so I didn't wanna hire randomly, and I was very particular because I had so many people try to send me resumes. Can you hire me? I'll work for free, I'll do this, I'll do that. But even if the work was for free, I wanted to make sure that it was the right fit. But it never happened. And so I ended up meeting Jacqueline through her brother, her brother Abraham, rotated when he was a student undergrad.
Um, at my clinic, my, my former clinic that I was employed at. And interestingly enough, I took care of his grandpa and I loved his grandpa and he loved me a lot. And, um, Abraham ended up not going to medical school, and now he's actually, uh, he got his m mba and he's, he's working for one of that same A c o I was a patient at.
And so his sister Jacqueline was, um, still a student at a and m, Texas a and m. And so he was like, Hey, can I give my information to your sister? And I said to my sister, I said, absolutely. Then I met her and she was wonderful. So in over the summer she was very trying to learn. She would go the extra mile and patients really liked her.
And so she just was worried that she was gonna graduate college and that she didn't have any opportunities to rotate because of Covid. And I told her, well, you can rotate here. I mean, if you like it. I said, you can do, you wanna work for me? And she was like, yes, absolutely. So she's been my right. And that's why I tell her that she is she, cuz that's what she is my right hand.
So she helps me doing, uh, assisting immune procedures. She, um, I've taught her phlo phlebotomy, I've taught her how to do Im injections, um, you know, and things like that. And so the goal is for her to go to medical school as well. And she has falling in love with Direct Primary Care and she tells me she wants to be a family medicine physician, which is one of the biggest compliments ever.
Um, so we use Spruce in my clinic. It's a really good app. It's, it's a voiceover IP where my patients can call in, uh, through, through the, through spruce. And, um, I am able to assign tasks to my, to my team. And so we are always on the same page. And so, for instance, I write Mr. X needs labs in three months.
Forward, uh, you know, uh, schedule a message for the date in three months, and I tag somebody on the team. Rosa is a wonderful, wonderful, wonderful woman with a lot of patience, and I love her so much. She's actually my mother. She is the, the, my biggest cheerleader. And so what's really cool is a lot of patients don't know that, right?
But they see how she does her job with so much love that I've had patients ask me, is she related to you? And I go, yeah, she's my mama. And so that's pretty cool. I've had patients bring cookies or bring things for her, and I'm like, well, she's not here. She's in New Mexico, but it's pretty cool. And so she has a fun time because she's no longer, you know, she was a phlebotomist for 20 plus years and she's not doing that because when Covid started, she just felt like it was safer for her to stay home because of her medical conditions.
And she was absolutely going crazy, not being able to do anything. And so she said, I can help you cuz after my sister went to medical school, I was going crazy. Just answering the phone, seeing the patients, triaging the patients. And so what I learned, which I should have learned a long time ago, is that you have to learn how to delegate your work so that I can be the physician.
Right? And there's nothing wrong with answering your own phones. There's nothing wrong with drawing your own labs, but able to halt your growth. And so by delegating certain things, you know, whether it's to Jacqueline or to Rosa, um, I've learned that for one, I can trust them. I don't micromanage them, but my, but we've, we've become such a good team, we're so efficient at the things that we do.
And so you have to trust the people that you're gonna hire, you're gonna work with. When you
are describing, you wore all the hats. Was there a time when there were no staff in the. Gotcha. And then once you started bringing staff into the office, whether that be Jacqueline or you know, a, a temporary person that you were trying, um, that you were interviewing before her, how did you go from, um, being in an office where you were the only staff member present to, um, bringing other people on when it comes to OSHA compliance?
Well, I did OSHA training and I had both Rosario and Jacqueline do HIPAA and OSHA training. And I think I got that through the Sharps people that I used for disposing my biohazards. They, they offered that, actually, I think Jacqueline did hers through a and m, um, cuz she did it free. And so that's how that got done.
You, you mentioned Spruce earlier, so I wanna ask you about the other tech that you used for your clinic. How did you decide on things like your E M R and other pieces of tech that you use to run your practice every day?
Perfect. So before I had about eight different systems and when I didn't have a lot of patients, I was like, this is manageable.
So I would use Sign Now to get patient intake. I would use Spruce, I would use the E M R, which is One Touch was a free E M R, and it was okay for what it was worth, but then I had no way to do like the practice management side, like who paid what. And so their practice management software was 2 25 and I was.
By the, by the end of like one patient visit, I would have to download things from sign down portal into the E M R. And it was just taking so much work. And I spoke to Rebecca Barons and she was like, what are you doing? I'm like, I don't know. I don't know what I'm doing. And so she goes, what don't you use an EMR that is more, you know, DPC friendly?
And I'm like, well, what is more DPC friendly than a free E M R? And so she was like, okay. So she used another E M R and she used Hint, so I used Serbo and Hint, which meant that I no longer had to pay for that. Software, which is 2 25, which also meant that I didn't have to use sign now for the intake cuz it's all integrated through Serbo.
So by just having that small conversation with Rebecca, um, Dr. Barons, she gave me a lot of insight of what could be done and just do things that more like automated. I would run the memberships through my, uh, point of sales system, which is Clover. But the issue that I was having is when a patient went from age 18th to 19, it wouldn't catch that.
So it was just too much for me to handle. And I said, okay, we have to clean house here. And so basically I just used Spruce, um, hint and Serbo. And um, the reason I love Serbo so much is because when I left that E M R, even though it was free and I no longer paid for the 2 25 a month for the management service, they wanted to charge $5,000 to import all my patient data.
And allow Servit to Serbo to import that into the new servo E M R and Ben, which I later found out was the owner of Serbo was like, that is ridiculous. We're not doing that. And he found a way around it and imported everything without any issues. So initially everything had imported fine except for the labs, which is one of the most important things cuz you need your labs to see, you know, how, how these chronic medical conditions are trending.
And Ben was, was awesome and he took care of that. And so I love cebo. I like how customizable it is and I wouldn't change it. Awesome.
And you dropped a great point that people should ask about when they are choosing an E M R or when they're interviewing EMRs. Um, what is the, if you decide to change EMRs in the future, what are the pros and cons about doing that per E M R, um, the system that you're looking at?
So, thank you for mentioning that. In terms of tech, this is not necessarily a SAS question, but when it comes to, um, the tech that your patients interact with your website, I wanted to highlight that you have a website and there's not too many out there. Um, but I love your website and I wanna highlight the fact that it comes in both English and Spanish.
Cuz you, you mentioned that the company that you had hired, um, for marketing, you know, did your website, did the blogs, but it seemed like a robot was involved. Did you have your website in Spanish and English from the beginning or was that something that developed based on your patient population?
So that's something that develops later.
And my website got done a total of three times. Okay. So the first time with that expensive company, the second time with a local guy, which did a good job, but I don't think he understood what T P C was. And it looked pretty, the website looked great, but I was like, this is not me. And then the third time I actually used, um, Alexa Salas, and she did a good job.
She also used wic and I learned because YouTube, you can learn all kinds of things and I had the time. And so she did like the basic layout and you know exactly what I told her. I gave her the content. And then, um, I translated it in Spanish, and she did that as well. So she basically copied the website in Spanish as well, and anything that I need to modify, so I added the F FAA portion, I added, um, I think it was the PDO O portion.
Um, I learned, I learned, and you just learned and, and you do it on your own. And so I, I liked that I went with wics. I've had some people reach out to me saying, oh, the SEO is not that good. It's all pretty, but it's not that good at this point. I don't care because, um, for me, what's been working, like I said, has been word of mouth and the, the SEO is good, but I mean, it's okay.
I know it's important, but it's not everything. How a lot of people put all their weight on that. And when
it comes to the term direct primary care in particular, when you translate that into Spanish for your Spanish speaking patients, or for people who are Spanish speaking as their first language, um, or who speak Spanish as their first language, Do.
Is there any confusion about the direct translation of Direct Primary Care, or how do you go about describing direct primary care as a model for those people who might not speak English as their first language?
Well, Spanish, even though I was born in New Jersey, Spanish is my first language, so I think in Spanish.
And so explaining it to them is not very hard for me. And so the thing is, I also wanted to reach out to, you know, Latinos and minorities in the community because they're the ones that usually have least access to care. And so I had to make sure that if I wanted to reach that population, my website had to be not only, um, that they can digest the information, but also had to be also available in Spanish.
And so that, that's very important. And actually, you just reminded me, one of my goals for this year is to make more reels, but also in Spanish, let people know that, you know, I do speak Spanish. And in terms of. Examples from your website where you've taken your, you know, your, because Spanish was your first language, and because you are talking with people who Spanish is also their first language and possibly their primary language, do you have any tips on physicians who are looking to create a bilingual or multilingual website?
Um, in terms of copy or in terms of strategy? When you are, um, when you look back on how your, how your website is bilingual. Actually, the story of my logo, when my aunt told me that it was in Spanish, you know, and I translated it to English about, you know, I swam in the borders and it's not time for me to drown at the shore.
Um, it was first in Spanish and I had a hard time translating it to English. The thing is, you have to make sure that you don't just use something like Google Translate, because if you just do that, it's not gonna sound phonetically. Correct. Right. And I also had people go over my website, um, that are better at, even though Spanish is my first language, I may not have very good written, um, written skills in, in Spanish.
So I've had my, uh, friends that have a friend who's a, who's a teacher, and, um, she only teaches in Spanish. I had her go over it. I had my parents go over it and just to make sure that it makes sense to the person that's reading it. And it was very important because I've had people that don't speak English, come to my, my clinic, and the translator would be a, a, you know, a family member.
And I would ask him questions. The family member would ask them, and the patient would give him like a two minute explanation. And then the translator would say, she's fine. And I'm like, look, I don't speak your language. But after two minutes of her rambling, I know she didn't just say, she's fine. You know?
So I had to make sure that at least for the Spanish speaking community, that they feel comfortable enough that they don't have to bring somebody into the room with, with them so they can explain exactly how they're feeling.
Gotcha. And with Houston being such a huge area, as you've explained, what have you done for translation services if you need, um, help with understanding
a patient?
Well, thankfully that's only happened one time, and the patient was from Croatia, and I just told, uh, the son who brought his mom, I, I need you to be present because otherwise I won't be able to communicate with, you know, with your mom. And so he was always there into visits. She ended up moving back to Croatia, but she would tell me, I can't wait to learn name, that she can just be me and you talking.
And I'm like, yeah, totally. That, that would be great.
So now that you have been open for quite some time, you've gone through many pivots, you've, you've, you've pivoted, you've learned, you've continued on. Um, I wanna ask about Doc d p c doctors reaching out to you when, when D P C doctors reach out to you, when they're thinking about D P C, when they're doing D P C, like, um, how you even said, you know, Jacqueline is thinking about D P C.
What are the main things that you suggest a person start with or start researching, um, given your experience in your clinic?
I tell these people that I'm trying to pay it forward and I want to be kind of like how the mentors of the d p c, you know, movement work to me. I wouldn't be that to them, but what I can't do is I can ask be spoonfeed you things.
So I have to see that there's effort on this physician's part. So not like, what do you think I should do? Or, uh, how do I do this? I mean, there's so many books on this, you know, so I try not to be snarky, but I said, look, if you want me to help you, I need you to first do some homework and please read this book and this book, and when you're done, you can holler at me and we can discuss it.
Um, because there has to be effort on this person's part. I can't just sit here and give you my free, valuable time and you're just not putting any effort on your behalf.
And along that same line of questioning, um, the last time I saw you in person was at the, uh, mastermind that Dr. Cla Ryan and Dr. Gupta had hosted in the Chicagoland area this last summer.
So, I wanna ask, what was the reason that you decided to go to a mastermind, given that you had already been practicing, um, in your D P C?
Well, because I had growing paint and because I was stuck at a number and I didn't know what else to do, I felt like I had gotten very creative in terms of my marketing.
I've done everything from, you know, the expensive marketing company to publishing in, uh, magazines, local magazines that everyone throws away, nobody reads to, you know, go door to door to, and it's just so many things and I'm like, okay, there has to be something that I'm missing here. Like, there has to be like, what am I doing wrong?
And so that's why I decided to go to the Mastermind and I got so much, so much valuable information from it. And, uh, one of the funny things that I mentioned at the, at the Mastermind, Was that one of the things that I did to market also, I went to a strip club and I took money out. I told my husband today, let's look nice.
We're going to a strip club. And he is like, why? I said, we're gonna market over there. And he's like, have you lost your mind? I said, no, I haven't. Those, those, those women have disposable income. They gotta look good, right? So let's just go. And I went and, you know, got my husband a lap dance, got me a lap dance, everything was great.
And I give out my card and yeah, two people showed up, which is a little less than I had expected, but whatever. It worked. So you just have to think outside the box, uh, to make, uh, to make things work for you. You don't have to do everything the way it's been done in the past.
That's awesome. And so when, um, when you talk about that the experience was valuable, um, who, who should think about going, like what other, what other big lessons or takeaways did you get from that mastermind?
I had a whole thing of notes, um, I can't remember off the top of my head right now, but, um, oh, how to fire a patient, how not to barter because that can get you in deep waters. And Dr. Ryan told me that. And I've had patients try to offer me, I'll give you some, you know, baked goods cuz I have sweet tooth.
If you can just, you know, waive my re-enrollment fee. I, I can't do that. I just can't. And so, had it been another time, I would've said, sure, let's do it. But mm-hmm I'm just holding, I'm just sticking to my boundaries. I've learned to say no and no feels so amazing that I don't have to please everybody. And that's just the way it's been.
It reminds me of, I have a, it reminds me of something that somebody had posted where Noah is, is an answer. Noah is a, Noah is a full sentence. So, uh, it's, it's definitely something that I think that as you go on. You, you definitely feel more comfortable using no as a sentence. Um, and if not, I think that if, if someone is not, I think that's a good reason to go to a mastermind.
Uh, you mentioned firing patients and lessons learned there. What did you learn specifically?
So what I didn't do before was when the patient would come in is I would never see their account as up to date. Cuz I would figured, of course they're good people, they're gonna pay me, but I got tiredly chasing people down for payment and it just got old.
And so then I spoke to my attorney and I go, what happens if I don't fire them? Um, because they haven't paid me. And his words were like, you're not a charity clinic. At the end of the day, you're a business. And what's gonna happen is you still have the duty to that patient even though that patient hasn't paid.
So your best bet is to fire them. You know, give yourself, give them some grace, right? To, to give their account up to date and then just dismiss them from the practice. Because that way you don't have any like, legal obligations other than the 30 day emergent care to them. So that, that's something that I've learned.
Um, now I wanna ask you, and I wanna. Change the, the subject a little bit. Um, I mentioned how you are such a trooper for doing this interview because you have a newborn at home. Um, how are you, aj, how are you adjusting to life with a newborn and being a D P C physician?
So luckily for me, my patients are also cheering for me.
They were very excited. They were very invested into this pregnancy just because I thought I was done having kids and apparently not, so, right. And so they saw me grow. They saw, they just saw me throughout every phase, right? And I told them initially that I was gonna have coverage and I, I had thought that my brother was gonna, you know, cover for me.
My brother's an ER physician, but he never took the JP exam for Texas. And he's like, I don't have time for that. And so then we had to go to plan B. And Plan B is basically me, right? So the clinic is still opened. Jacqueline can still do like, um, take photos and just weigh ins on the end body when the patient.
Are due for their monthly photos or whatnot. And I can still refill their medications. I did tell them let's limit, um, you know, the phone calls and, um, the, the video visits because, um, I'm recovering, right? I had a c-section, what, 10 days ago? No, yeah, 10 days ago. Um, but I tell 'em that I'm still available to them.
And so like if they're, they're, I had this one lady with a really bad sinus infection. It's, don't tell me the diagnosis cuz I, I do that, but tell me, write me a book. And this la lady literally wrote me a book. Like, that portal message was so long. I was like, oh my God, I need a coffee break. Sure enough, she had a sinus infection.
I gave her antibiotics. So my patients for the most part have been very understanding. I've had a couple that have been not so much understanding like, oh my god, you know, I need to refill my Adderall. Okay, we'll refer to the patient guidelines cuz refills can take up to a week. And again, I had built that habit that once they submit that refill request, I would refill it right then and there.
Well, this is one of those times where this is backfiring on me because I'm not refilling it that same day. Right? I've had this baby 10 days ago and so I've been telling Jeff, reminding these people to go back and read the the clinic guidelines that they agreed to and you. They're not gonna die if they don't have Adderall.
Right. That's just the truth. But I, I did refill their medicines, right, because they need it, but not just right then and there. Because right now the most important thing is it's my baby. My baby's the most important thing right now. And me being okay, and I tell that to my patients, if y'all want me to take care of you, I need to be okay up here.
Like, I have to be of sound, mind and spirit so I can give you the best care. And when you frame, when you, when you, um, pose it like that, they understand. And there's some days that I'm overwhelmed with life, and there's some days that I'm like, you know what? I need to take a day off. I'm not coming into the office.
And just letting them know that I'm just as human as they are. And I go through the same struggles as a parent, as a mother, as a wife, like they do. They're, they're so empathetic in this situation. So I'm very grateful that the patients that I have, uh, value me as a person, right. And as their physician.
And yeah, that, that's, that's just the way it's been. It's been great.
Well, again, I and the audience and the listeners greatly appreciate you taking the time out of your schedule with a newborn to share your story. And thank you again so much for, for doing this, and I can't wait to see you at the D P C summit this year.
Yay, we're gonna party. So, fun fact, I was actually pregnant at the DP C Summit last year and I didn't know that. Um, but I, there I was living my best life cause I had no kids, no husband. I didn't have to drive nowhere. And I just had fun. I'm looking forward to reconnecting with people. I'm looking forward to seeing, uh, some of my, you know, really good friends, including you there and just keeping you up to date of what's been going on.
I have a lot of, uh, career goals that I want to accomplish. But I'm gonna leave that off till till next time until I get there and I can say, Hey, I didn't.
So thank you so much again for taking time out of your, your newborn schedule to share your story. And I, I wanna close with asking, do you have any last words to share
with the audience?
All I can tell everyone is to keep showing up for yourself. There's sometimes that, you know, things get rough and just rely on your tribe. And keep in mind that everyone thinks that just being a D P C doctor is this glamorous thing, right? Because you're your own boss, but there's a lot of ups and downs that occur, but you have this vision.
I told my husband, I will never, ever, ever go back to the traditional service. So this is gonna work and I'm gonna make it work. And so that's why I'm telling you guys to just not give up, rely on your mentors, on your friends, and this you can practice medicine happily. I love that Dr. Deep DE's. Um, Name is like my happy doctor cuz I can kid you not, I'm the second happiest doctor.
She's number one cuz she claimed it, but I promise you I'm number two and everyone knows that and it just shows, it just shines right? Um, the way I do things with my patients because I am embracing my freedom and I'm doing that with D P C.
Next week look forward to hearing from Dr. Cheung of Lotus Health and Wellness in Mishawaka, Indiana. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with the physician. You may know who needs to hear about D P C. Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all these DP C stories.
Lastly, be sure to follow us on social media. If you're wanting to continue learning more about dpc in the meantime, check out DPC news.com. Until next week, this is Marielle conception.
*Transcript generated by AI so please forgive errors.